Healthcare Provider Details

I. General information

NPI: 1659494698
Provider Name (Legal Business Name): P WILLIAM HAAKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 QUAKER RD
SCOTTSVILLE NY
14546-9635
US

IV. Provider business mailing address

712 QUAKER RD
SCOTTSVILLE NY
14546-9635
US

V. Phone/Fax

Practice location:
  • Phone: 585-889-1958
  • Fax: 585-889-1958
Mailing address:
  • Phone: 585-889-1958
  • Fax: 585-889-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number097375-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: