1194896241 NPI number — DIANE LOIS HABER MS, RN, CS

Table of content: (NPI 1366629750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194896241 NPI number — DIANE LOIS HABER MS, RN, CS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABER
Provider First Name:
DIANE
Provider Middle Name:
LOIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RN, CS
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:
1194896241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5846 246TH CRES
Provider Second Line Business Mailing Address:
58-46 246 CRESCENT
Provider Business Mailing Address City Name:
DOUGLASTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11362-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-224-5235
Provider Business Mailing Address Fax Number:
718-224-9498

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5331 MARATHON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLASTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11362-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-224-5235
Provider Business Practice Location Address Fax Number:
718-224-9498
Provider Enumeration Date:
11/12/2006

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: 163WP0809X , with the licence number:  148362-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13870 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 107748 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1483626822 . This is a "HIP" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 7369085 . This is a "MAGELLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: R0081 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".




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