Provider Demographics
NPI:1477121531
Name:BAWA, HABIBI
Entity Type:Individual
Prefix:MISS
First Name:HABIBI
Middle Name:
Last Name:BAWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GRUMMAN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2316
Mailing Address - Country:US
Mailing Address - Phone:646-961-6183
Mailing Address - Fax:
Practice Address - Street 1:40 GRUMMAN AVE APT 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2316
Practice Address - Country:US
Practice Address - Phone:646-961-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ04506266322278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health