Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 042179 | CT |
NPI | 1003857707 |
---|---|
Provider Name | Dr. Mohammad Aljanaby |
First Address | West Hartford, CT 06119-1853 |
Second Address | West Hartford, CT 06119-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 24/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001421792 | (05) | CT |
11528277 | CAQH (01) | CT |