=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629105333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY I HABER MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 NW 126TH WAY
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-5414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-344-8170
-----------------------------------------------------
Fax | 954-344-5276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 NW 126TH WAY
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-5414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-344-8170
-----------------------------------------------------
Fax | 954-344-5276
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | DR. JEFFREY IRA HABER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-344-8170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | ME48510
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------