Healthcare Provider Details

I. General information

NPI: 1306100086
Provider Name (Legal Business Name): IMNETT HABTES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS STE 202
ST THOMAS VI
00802-3132
US

IV. Provider business mailing address

280 1ST ST APT 2M
MINEOLA NY
11501-2315
US

V. Phone/Fax

Practice location:
  • Phone: 727-519-5027
  • Fax: 340-715-7949
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2589
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: