Provider Demographics
NPI:1043217649
Name:HABERMAN-JOHNSON, WENDY (PT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HABERMAN-JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-0485
Mailing Address - Country:US
Mailing Address - Phone:845-304-3573
Mailing Address - Fax:
Practice Address - Street 1:1029 MACARTHUR BLVD.
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3613
Practice Address - Country:US
Practice Address - Phone:845-304-3573
Practice Address - Fax:888-783-0123
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0160932251X0800X
NJ40QA006733002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ20J81Medicare ID - Type Unspecified