Provider Demographics
NPI:1396747267
Name:LABIAK, JOHN
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LABIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2916
Mailing Address - Country:US
Mailing Address - Phone:631-265-1855
Mailing Address - Fax:
Practice Address - Street 1:290 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2916
Practice Address - Country:US
Practice Address - Phone:631-265-1855
Practice Address - Fax:631-724-2579
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173947207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477710Medicaid
NYF40509Medicare UPIN
NY92K371Medicare PIN