Healthcare Provider Details

I. General information

NPI: 1952764300
Provider Name (Legal Business Name): YASSER TAJALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YASER TAJALIZADEKHOOB MD

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 LITCHFIELD ST STE 3
TORRINGTON CT
06790-6268
US

IV. Provider business mailing address

1290 SILAS DEANE HWY HARTFORD HEALTHCARE-CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-3600
  • Fax: 860-626-8233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number72153
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: