1083751770 NPI number — PHILIP I. HABER, LTD.

Table of content: (NPI 1083751770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083751770 NPI number — PHILIP I. HABER, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP I. HABER, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083751770
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11123 TIMBERHEAD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20191-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-476-2348
Provider Business Mailing Address Fax Number:
703-476-6013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12050 S LAKES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20191-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-476-2348
Provider Business Practice Location Address Fax Number:
703-476-6013
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HABER
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
I.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-476-2348

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701000976 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 0904000882 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 158333 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7233-0001 . This is a "CARE FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30679 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7751097 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1036558 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126400 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223114 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7650215 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7233-0004 . This is a "CARE FIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 063138 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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