Healthcare Provider Details

I. General information

NPI: 1770515678
Provider Name (Legal Business Name): MICHAEL C HABEN MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 WESTFALL RD BLDG 100, STE 127
ROCHESTER NY
14618-2605
US

IV. Provider business mailing address

980 WESTFALL RD BLDG 100, STE 127
ROCHESTER NY
14618-2605
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-1110
  • Fax: 585-730-8151
Mailing address:
  • Phone: 585-442-1110
  • Fax: 585-730-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number230501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: