Healthcare Provider Details

I. General information

NPI: 1780632968
Provider Name (Legal Business Name): MAYER JOSHUA HASBANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVE SUITE 505
NEW HAVEN CT
06511-5238
US

IV. Provider business mailing address

136 SHERMAN AVE SUITE 505
NEW HAVEN CT
06511-5238
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-8071
  • Fax: 203-562-1317
Mailing address:
  • Phone: 203-562-8071
  • Fax: 203-562-1317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number044073
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: