# STATE OF CONNECTICUT HEALTH CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATE OF CONNECTICUT HEALTH CENTER
- **Other names:** Pediatric Hematology/Oncology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669656575
- **Legal business name:** STATE OF CONNECTICUT HEALTH CENTER
- **Authorized official:** DENIS C LAFRENIERE MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (860) 679-7503

## Contact information

- **Practice address:** 263 FARMINGTON AVE, PEDIATRIC HEMATOLOGY/ONCOLOTY, FARMINGTON, CT 06030-0001
- **Practice address phone:** (860) 679-2100
- **Practice address fax:** (860) 679-4815
- **Mailing address:** 263 FARMINGTON AVE, PROVIDER ENROLLMENT - PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
- **Mailing address phone:** (860) 679-7503
- **Mailing address fax:** (860) 679-1610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080P0207X | Pediatric Hematology & Oncology Physician | — | CT | Yes |

## Other

- **Enumeration date:** 12/27/2007
- **Last updated:** 07/21/2022