1538211636 NPI number — CONSTANCE D HABER DC

Table of content: CONSTANCE D HABER DC (NPI 1538211636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538211636 NPI number — CONSTANCE D HABER DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABER
Provider First Name:
CONSTANCE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1538211636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2571 MOSSIDE BLVD
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-3576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-372-7900
Provider Business Mailing Address Fax Number:
412-372-7911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2571 MOSSIDE BLVD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MONROEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15146-3576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-372-7900
Provider Business Practice Location Address Fax Number:
412-372-7911
Provider Enumeration Date:
01/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NT0100X , with the licence number:  001169L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: 001169L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: DC-001169-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00631206 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".