Provider Demographics
NPI:1578735379
Name:MAGED S. HABIB, M.D. P.A.
Entity Type:Organization
Organization Name:MAGED S. HABIB, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-742-1944
Mailing Address - Street 1:2300 S CONGRESS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7400
Mailing Address - Country:US
Mailing Address - Phone:561-742-1944
Mailing Address - Fax:561-742-0525
Practice Address - Street 1:2300 S CONGRESS AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7400
Practice Address - Country:US
Practice Address - Phone:561-742-1944
Practice Address - Fax:561-742-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77394332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257361000Medicaid
FL257361000Medicaid
FLG99899Medicare UPIN
5073570001Medicare NSC