Provider Demographics
NPI:1538130802
Name:HABERMAN, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:HABERMAN
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 1:875 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-931-1710
Mailing Address - Fax:516-931-2362
Practice Address - Street 1:875 OLD COUNTRY RD
Practice Address - Street 2:SUITE 301
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-931-1710
Practice Address - Fax:516-931-2362
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166413208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW13411Medicare ID - Type Unspecified
E62072Medicare UPIN