Basic Information
| Provider Information | |||||||||
| NPI: | 1659423937 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HABER | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 EAST 77TH STREET | ||||||||
| Address2: | |||||||||
| City: | NYC | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124346279 | ||||||||
| FaxNumber: | 2124342446 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 1ST AVE # HCC4G | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6465012465 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | P36094 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 2499048 | 01 | GHI PPO | OTHER | P3462297 | 01 | OXFORD | OTHER | 2458969 | 01 | UNITED HEALTH CARE | OTHER | 3680094 | 01 | AETNA HMO | OTHER | 4V3021 | 01 | BCBS | OTHER | 7817592 | 01 | AETNA PPO | OTHER | 000000087161 | 01 | GHI HMO | OTHER | 180865P | 01 | HIP | OTHER |