Provider Demographics
NPI:1992737449
Name:CONNECTICUT ONCOLOGY&HEMATOLOGY, LLP
Entity type:Organization
Organization Name:CONNECTICUT ONCOLOGY&HEMATOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LOWENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-482-5384
Mailing Address - Street 1:200 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3096
Mailing Address - Country:US
Mailing Address - Phone:860-482-5384
Mailing Address - Fax:860-496-4951
Practice Address - Street 1:200 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3096
Practice Address - Country:US
Practice Address - Phone:860-482-5384
Practice Address - Fax:860-496-4951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
364SX0200X, 207RX0202X, 207RH0003X, 207U00000X, 291U00000X
CT003622363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004049763Medicaid
CT008002184Medicaid
CD0030OtherPALMETTO GBA-RR RETIREMENT
CT008002184Medicaid
CT690000312Medicare ID - Type UnspecifiedTORR. LAB
CT008002184Medicaid
CTD400000299Medicare PIN
CT690000347Medicare ID - Type UnspecifiedSHARON LAB