Provider Demographics
NPI:1568552115
Name:HABACKER, TERESA AIMEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:AIMEE
Last Name:HABACKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:SCHULLY
Other - Last Name:HABACKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-473-4263
Mailing Address - Fax:631-473-4260
Practice Address - Street 1:5954 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-2001
Practice Address - Country:US
Practice Address - Phone:631-473-4263
Practice Address - Fax:631-473-4260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184539174400000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02925937Medicaid
G61564Medicare UPIN
CA00G842750Medicare ID - Type Unspecified
NY02925937Medicaid