Provider Demographics
NPI:1154160414
Name:HABER, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:HABER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 NOTTINGHAMSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1244
Mailing Address - Country:US
Mailing Address - Phone:267-246-4259
Mailing Address - Fax:
Practice Address - Street 1:2281 NOTTINGHAMSHIRE RD
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1244
Practice Address - Country:US
Practice Address - Phone:267-246-4259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR23815300163W00000X
PASP029234363L00000X
NJ26NJ15078400363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner