Provider Demographics
NPI:1245483429
Name:HAVEN MEDICAL P.C.
Entity type:Organization
Organization Name:HAVEN MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:
Authorized Official - Last Name:AIZIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-385-1525
Mailing Address - Street 1:9311 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2745
Mailing Address - Country:US
Mailing Address - Phone:516-385-1525
Mailing Address - Fax:516-385-1519
Practice Address - Street 1:9311 91ST AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2745
Practice Address - Country:US
Practice Address - Phone:516-385-1525
Practice Address - Fax:516-385-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085638-1261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW44301Medicare PIN