Healthcare Provider Details

I. General information

NPI: 1265482384
Provider Name (Legal Business Name): YOUSSEF MOUSSA HORANIEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WOODLAND STREET BREAST CENTER
HARTFORD CT
06105-0000
US

IV. Provider business mailing address

1000 ASYLUM AVE SUITE 2109A
HARTFORD CT
06105-1770
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-6318
  • Fax:
Mailing address:
  • Phone: 860-714-6581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number018813
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: