Provider Demographics
NPI:1144227596
Name:HABER, IRVING I (DO)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:I
Last Name:HABER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4041
Mailing Address - Country:US
Mailing Address - Phone:812-478-9494
Mailing Address - Fax:812-478-9393
Practice Address - Street 1:1818 N 3RD ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4041
Practice Address - Country:US
Practice Address - Phone:812-478-9494
Practice Address - Fax:812-478-9393
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X
IN020014352081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200350460AMedicaid
IN000000089341OtherBC/BS PROVIDER NUMBER
IN0638910001OtherMEDICARE NSC
INF59458Medicare UPIN
IN859660Medicare ID - Type Unspecified