Healthcare Provider Details

I. General information

NPI: 1700574944
Provider Name (Legal Business Name): DANIEL JALIL GHAJAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ISHAM RD STE 150
WEST HARTFORD CT
06107-2204
US

IV. Provider business mailing address

30 JORDAN LANE PRIME HEALTHCARE, PC
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-527-1669
  • Fax: 860-293-0783
Mailing address:
  • Phone: 860-845-0905
  • Fax: 860-913-2587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85841
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: