Provider Demographics
NPI:1447250980
Name:HABERMAN, SHOSHANA (MD, PHD, FACOG)
Entity type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:
Last Name:HABERMAN
Suffix:
Gender:F
Credentials:MD, PHD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5014 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3324
Practice Address - Country:US
Practice Address - Phone:718-283-8943
Practice Address - Fax:718-283-6818
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184135-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01299238Medicaid
NY15G482Medicare ID - Type Unspecified
NYF20946Medicare UPIN