Provider Demographics
NPI:1508941964
Name:HABER, PATRICIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:L
Last Name:HABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 OLD COLONY RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3618
Mailing Address - Country:US
Mailing Address - Phone:718-881-0100
Mailing Address - Fax:718-881-7752
Practice Address - Street 1:64 OLD COLONY RD
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3618
Practice Address - Country:US
Practice Address - Phone:718-881-0100
Practice Address - Fax:718-881-7752
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01228431Medicaid
NYB18601Medicare UPIN