Provider Demographics
NPI:1194896241
Name:HABER, DIANE LOIS (MS, RN, CS)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOIS
Last Name:HABER
Suffix:
Gender:F
Credentials:MS, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 246TH CRES
Mailing Address - Street 2:58-46 246 CRESCENT
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2028
Mailing Address - Country:US
Mailing Address - Phone:718-224-5235
Mailing Address - Fax:718-224-9498
Practice Address - Street 1:5331 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1720
Practice Address - Country:US
Practice Address - Phone:718-224-5235
Practice Address - Fax:718-224-9498
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148362-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13870OtherVALUE OPTIONS
NY107748OtherMHN
NV1483626822OtherHIP
NY7369085OtherMAGELLAN
R0081OtherBLUE CROSS
NY13870OtherVALUE OPTIONS
NYS44519Medicare UPIN