Taha Waleed Al Hassan
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · New Haven, CT
NPI 1851996979 · NPPES record last updated Jun 3, 2025
Key facts
- NPI
- 1851996979
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 20 York St
New Haven, CT 06510-3220 - Phone
- (203) 688-4242
- NPI assigned
- Dec 4, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250624002669 | CT | Order and Referring Only - Otolaryngology |
8224540364 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36851 | TX | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 36851 | TX | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
20 York St
New Haven, CT 06510-3220
Mailing address
20 York St
New Haven, CT 06510-3220
Phone (203) 688-4242
Other practice location 1
518 S Closner Blvd
Edinburg, TX 78539-4660
Phone (956) 287-4751
Other providers in New Haven, CT
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- Merve Akyol
- Omar Ahmad Al Asad
- Badr F Al Bawardy
- Caroline Sami Al Haddadin
- Karam Al Jumaily
- Hisham Al Kukhun
- MHD Yassin Al Mouslmani
- Osama Al Safarjalani
- Mohammed Sulaiman Al Zakwani
All providers in New Haven, CT · Student in an Organized Health Care Education/Training Program in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.