Provider Demographics
NPI:1104893908
Name:HABASH, HANNA J (MD)
Entity type:Individual
Prefix:DR
First Name:HANNA
Middle Name:J
Last Name:HABASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:570-882-3007
Practice Address - Street 1:123 CONHOCTON ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2959
Practice Address - Country:US
Practice Address - Phone:607-973-8600
Practice Address - Fax:607-973-5102
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198707-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080089366OtherRR MEDICARE PIN
NY01559186Medicaid
PA0015244700001Medicaid
NYCC8362OtherRR MEDICARE GROUP
F98757Medicare UPIN