MEDICARE: DR. JORDAN LLOYD HABER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	117031	NY

General Provider Information

NPI Number	:	1649567215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN LLOYD HABER

Provider Business Mailing Address
First Line	:	1 GREENBRIAR LN
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5313
Country	:	US
Telephone Number	:	516-639-3719
Fax Number	:	631-462-0710

Provider Business Practice Location Address
First Line	:	1 GREENBRIAR LN
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5313
Country	:	US
Telephone Number	:	516-639-3719
Fax Number	:	631-462-0710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	07/05/2011

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