Provider Demographics
NPI:1376507806
Name:HABER-KUO, SHERYL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:ANN
Last Name:HABER-KUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1953
Mailing Address - Country:US
Mailing Address - Phone:609-586-9566
Mailing Address - Fax:609-586-9055
Practice Address - Street 1:2312 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE #201
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1953
Practice Address - Country:US
Practice Address - Phone:609-586-9566
Practice Address - Fax:609-586-9055
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ63867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ884770Medicare ID - Type Unspecified
NJG33009Medicare UPIN