Provider Demographics
NPI:1023041092
Name:HAVA, NILOFAR K (MD)
Entity Type:Individual
Prefix:
First Name:NILOFAR
Middle Name:K
Last Name:HAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-4216
Mailing Address - Country:US
Mailing Address - Phone:631-348-4900
Mailing Address - Fax:631-348-0273
Practice Address - Street 1:1 KINGS HWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4216
Practice Address - Country:US
Practice Address - Phone:631-348-4900
Practice Address - Fax:631-348-0273
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF66825Medicare UPIN
NY0295ADMedicare ID - Type Unspecified