Provider Demographics
NPI:1407804545
Name:MOSHE HASBANI, M.D.
Entity Type:Organization
Organization Name:MOSHE HASBANI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-562-8071
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT018355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00840Medicare PIN