Provider Demographics
NPI:1598046633
Name:HABERLI, EDWARD GERARD II (LAC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:GERARD
Last Name:HABERLI
Suffix:II
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4222
Mailing Address - Country:US
Mailing Address - Phone:203-631-2612
Mailing Address - Fax:
Practice Address - Street 1:80 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4222
Practice Address - Country:US
Practice Address - Phone:203-631-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000543171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist