Provider Demographics
NPI:1083273320
Name:PETER M. HABASHY, PA
Entity Type:Organization
Organization Name:PETER M. HABASHY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HABASHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-254-4950
Mailing Address - Street 1:4388 GOLFERS CIR W
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4632
Mailing Address - Country:US
Mailing Address - Phone:561-254-4950
Mailing Address - Fax:
Practice Address - Street 1:4595 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 103 AND 114
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418
Practice Address - Country:US
Practice Address - Phone:561-427-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty