Healthcare Provider Details

I. General information

NPI: 1447250980
Provider Name (Legal Business Name): SHOSHANA HABERMAN MD, PHD, FACOG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5014 FORT HAMILTON PKWY
BROOKLYN NY
11219-3324
US

IV. Provider business mailing address

967 48TH ST
BROOKLYN NY
11219-2919
US

V. Phone/Fax

Practice location:
  • Phone: 718-283-8943
  • Fax: 718-283-6818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number184135-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: