Healthcare Provider Details

I. General information

NPI: 1477568053
Provider Name (Legal Business Name): MARTIN P HASENFELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ORCHARD ST SUITE 316
NEW HAVEN CT
06511-4417
US

IV. Provider business mailing address

330 ORCHARD ST SUITE 316
NEW HAVEN CT
06511-4417
US

V. Phone/Fax

Practice location:
  • Phone: 203-781-3400
  • Fax: 203-781-3414
Mailing address:
  • Phone: 203-781-3400
  • Fax: 203-781-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number034941
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: