Provider Demographics
NPI:1174755169
Name:HABEN PRACTICE FOR VOICE & LARYNGEAL LASER SURGERY PLLC
Entity type:Organization
Organization Name:HABEN PRACTICE FOR VOICE & LARYNGEAL LASER SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HABEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSC
Authorized Official - Phone:585-727-5436
Mailing Address - Street 1:980 WESTFALL RD
Mailing Address - Street 2:SUITE 1-127
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2605
Mailing Address - Country:US
Mailing Address - Phone:585-727-5436
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:980 WESTFALL RD
Practice Address - Street 2:SUITE 1-127
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2605
Practice Address - Country:US
Practice Address - Phone:585-727-5436
Practice Address - Fax:999-999-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230501174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY230501OtherLICENSE
NY02553175Medicaid
NY02553175Medicaid
NY02553175Medicaid
RA0402Medicare PIN