1689859951 NPI number — HABER DERMATOLOGY INC.

Table of content: (NPI 1689859951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689859951 NPI number — HABER DERMATOLOGY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HABER DERMATOLOGY INC.
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:
6
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:
1689859951
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26949 CHAGRIN BLVD #300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-932-5200
Provider Business Mailing Address Fax Number:
216-932-5212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26949 CHAGRIN BLVD #300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-932-5200
Provider Business Practice Location Address Fax Number:
216-932-5212
Provider Enumeration Date:
01/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HABER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
216-932-5200

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 35064474 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0123182 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2885267 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com