Provider Demographics
NPI:1275772899
Name:HABIB, BARRY HERTZL (DMD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:HERTZL
Last Name:HABIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E ECKERSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-7154
Mailing Address - Country:US
Mailing Address - Phone:845-501-4677
Mailing Address - Fax:845-501-4683
Practice Address - Street 1:200 E ECKERSON RD STE 260
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-7154
Practice Address - Country:US
Practice Address - Phone:845-501-4677
Practice Address - Fax:845-501-4683
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics