Provider Demographics
NPI:1265482384
Name:HORANIEH, YOUSSEF MOUSSA (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:MOUSSA
Last Name:HORANIEH
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 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:
Practice Address - Street 1:95 WOODLAND STREET
Practice Address - Street 2:BREAST CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-0000
Practice Address - Country:US
Practice Address - Phone:860-714-6318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001188135Medicaid
B83813Medicare UPIN
CT001188135Medicaid