Provider Demographics
NPI:1790889871
Name:HAZLETON GENERAL AND OSTEOPATHIC
Entity Type:Organization
Organization Name:HAZLETON GENERAL AND OSTEOPATHIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-459-2070
Mailing Address - Street 1:52 E MARKET STREET
Mailing Address - Street 2:PO BOX 240
Mailing Address - City:TRESCKOW
Mailing Address - State:PA
Mailing Address - Zip Code:18254
Mailing Address - Country:US
Mailing Address - Phone:570-459-2070
Mailing Address - Fax:570-459-2072
Practice Address - Street 1:52 E MARKET STREET
Practice Address - Street 2:
Practice Address - City:TRESCKOW
Practice Address - State:PA
Practice Address - Zip Code:18254
Practice Address - Country:US
Practice Address - Phone:570-459-2070
Practice Address - Fax:570-459-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009036L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015831860013Medicaid
PA892006Medicare ID - Type Unspecified
G34942Medicare UPIN