Provider Demographics
NPI:1689996563
Name:TERESA A. HABACKER, M.D.,P.C.
Entity Type:Organization
Organization Name:TERESA A. HABACKER, M.D.,P.C.
Other - Org Name:D/B/A EAST END HAND SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:AIMEE
Authorized Official - Last Name:HABACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-473-4263
Mailing Address - Street 1:5954 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2001
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184539-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100025774Medicare PIN