Provider Demographics
NPI:1053319475
Name:HABER, LAURENCE D (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:D
Last Name:HABER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 NORTHERN BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-498-1122
Mailing Address - Fax:516-466-6714
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5200
Practice Address - Country:US
Practice Address - Phone:516-498-1122
Practice Address - Fax:516-466-6714
Is Sole Proprietor?:No
Enumeration Date:2005-07-10
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY169382-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE814910Medicare UPIN
NY81F741Medicare PIN