Provider Demographics
NPI:1225022973
Name:HASBANI, MOSHE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:
Last Name:HASBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-562-8071
Mailing Address - Fax:203-562-1317
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-562-8071
Practice Address - Fax:203-562-1317
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0183552084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT130000070Medicare ID - Type Unspecified
CTB84319Medicare UPIN