MEDICARE: WENDY HABERMAN-JOHNSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	016093	NY
2	2251X0800X	Orthopedic Physical Therapist	40QA00673300	NJ

General Provider Information

NPI Number	:	1043217649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY HABERMAN-JOHNSON PT

Provider Business Mailing Address
First Line	:	PO BOX 485
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-0485
Country	:	US
Telephone Number	:	845-304-3573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 MACARTHUR BLVD.
Second Line	:
City	:	MAHWAH
State	:	NJ
Zip	:	07430-3613
Country	:	US
Telephone Number	:	845-304-3573
Fax Number	:	888-783-0123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	04/17/2013

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