Provider Demographics
NPI:1083671861
Name:HABIB, TAIMUR (MD)
Entity Type:Individual
Prefix:DR
First Name:TAIMUR
Middle Name:
Last Name:HABIB
Suffix:
Gender:M
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:C/O NORTHEAST MEDICAL GROUP, INC.
Mailing Address - Street 2:226 MILL HILL AVE., 3RD FLOOR
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:475-319-6035
Mailing Address - Fax:
Practice Address - Street 1:C/O NORTHEAST MEDICAL GROUP, INC.
Practice Address - Street 2:226 MILL HILL AVE., 3RD FLOOR
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2826
Practice Address - Country:US
Practice Address - Phone:475-319-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT055653207RG0300X
WI51116208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist