Provider Demographics
NPI:1770515678
Name:HABEN, MICHAEL C (MD, MSC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:HABEN
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 WESTFALL RD
Mailing Address - Street 2:BLDG 100, STE 127
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2605
Mailing Address - Country:US
Mailing Address - Phone:585-442-1110
Mailing Address - Fax:585-730-8151
Practice Address - Street 1:980 WESTFALL RD
Practice Address - Street 2:BLDG 100, STE 127
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2605
Practice Address - Country:US
Practice Address - Phone:585-442-1110
Practice Address - Fax:585-730-8151
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230501207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02553175Medicaid
NYG0182467590OtherBLUE CHOICE
NY000924636001OtherCOMMUNITY BLUE
NYMDH700OtherPREFERRED CARE
NY7827465OtherAETNA
NYP010230501OtherBLUE SHIELD
NYG0182467590OtherBLUE CHOICE
NYH99960Medicare UPIN