Provider Demographics
NPI:1659494698
Name:HAAKE, P WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:P
Middle Name:WILLIAM
Last Name:HAAKE
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 1:712 QUAKER RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14546-9635
Mailing Address - Country:US
Mailing Address - Phone:585-889-1958
Mailing Address - Fax:585-889-1958
Practice Address - Street 1:712 QUAKER RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14546-9635
Practice Address - Country:US
Practice Address - Phone:585-889-1958
Practice Address - Fax:585-889-1958
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097375-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB72072Medicare UPIN