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General NPI Number Information
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NPI Number | 1255536561
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Entity Type | Organization
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Legal Business Name | JONATHAN HABER DPM PA
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 519 BLOOMFIELD AVE SUITE L 18
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City | CALDWELL
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State | NJ
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Zip | 07006-5550
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Country | US
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Telephone | 973-228-5042
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Fax | 973-228-2826
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Provider Business Mailing Address
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Address Line | 519 BLOOMFIELD AVE SUITE L 18
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City | CALDWELL
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State | NJ
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Zip | 07006-5550
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Country | US
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Telephone | 973-228-5042
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Fax | 973-228-2826
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CHERYL A HUDSON
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Credential | CMA
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Telephone | 972-228-5042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 25MD00100400
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License Number State | NJ
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