Basic Information
| Provider Information | |||||||||
| NPI: | 1821205428 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FARZANA HABIB | ||||||||
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| OtherOrganizationName: | NEWFANE OB GYN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 NIAGARA FALLS BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | N TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141202019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
| FaxNumber: | 7166924342 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 PROFESSIONAL PKWY | ||||||||
| Address2: | |||||||||
| City: | LOCKPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140945368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167786246 | ||||||||
| FaxNumber: | 7166924342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HABIB | ||||||||
| AuthorizedOfficialFirstName: | FARZANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7167786240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 239667 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 02798552 | 05 | NY | MEDICAID |