Provider Demographics
NPI:1902119514
Name:HABIB, JAHANGIR (DPM)
Entity type:Individual
Prefix:DR
First Name:JAHANGIR
Middle Name:
Last Name:HABIB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:HABIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:602 E 21ST ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1269
Mailing Address - Country:US
Mailing Address - Phone:610-330-9740
Mailing Address - Fax:610-432-4887
Practice Address - Street 1:602 E 21ST ST STE 400
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1269
Practice Address - Country:US
Practice Address - Phone:610-330-9740
Practice Address - Fax:610-432-4887
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006248213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102581026Medicaid
PA102581026Medicaid