Provider Demographics
NPI:1275772899
Name:HABIB, BARRY HERTZL (DMD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:HERTZL
Last Name:HABIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 PARK BLVD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-2743
Mailing Address - Country:US
Mailing Address - Phone:516-797-1300
Mailing Address - Fax:516-797-7522
Practice Address - Street 1:1035 PARK BLVD
Practice Address - Street 2:SUITE 1D
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2743
Practice Address - Country:US
Practice Address - Phone:516-797-1300
Practice Address - Fax:516-797-7522
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics