Healthcare Provider Details

I. General information

NPI: 1316903206
Provider Name (Legal Business Name): JONATHAN E HASSON M.D., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/20/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE SUITE 203
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

455 LEWIS AVE SUITE 203
MERIDEN CT
06451-2121
US

V. Phone/Fax

Practice location:
  • Phone: 203-634-1900
  • Fax: 203-634-1895
Mailing address:
  • Phone: 203-634-1900
  • Fax: 203-634-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number045003
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: