Healthcare Provider Details

I. General information

NPI: 1194896241
Provider Name (Legal Business Name): DIANE LOIS HABER MS, RN, CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5331 MARATHON PKWY
DOUGLASTON NY
11362-1720
US

IV. Provider business mailing address

5846 246TH CRES 58-46 246 CRESCENT
DOUGLASTON NY
11362-2028
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-5235
  • Fax: 718-224-9498
Mailing address:
  • Phone: 718-224-5235
  • Fax: 718-224-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number148362-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: