Active NPI
Olivia Habacon
- Pediatrics Physician
- Jamaica, NY
National Provider Identifier
1124102165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 142245
- Practice address
- 9016 Sutphin Blvd
Jamaica, NY 11435-3636 - Phone
- (718) 523-5500
- Fax
- (718) 658-8260
- NPI assigned
- Oct 25, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 142245 | NY | Primary |
Addresses
Primary practice location
9016 Sutphin Blvd
Jamaica, NY 11435-3636
Mailing address
80 Marcus Dr
Melville, NY 11747-4230
Phone (631) 391-8366
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00564627 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 142245 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TJH Medical Services, PC | Past | Accepting new patients | |
| JHMC Diagnostic and Treatment Center | Pediatrics | Past | Accepting new patients |
| TJH Medical Services, P.C. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Jamaica, NY
- NPI 1821045485
Pediatrics
-
- Multi-Specialty Clinic/Center
- Jamaica, NY
- NPI 1588605802
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358467200000",
"number": "1124102165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 MARCUS DR",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474230",
"telephone_number": "631-391-8366",
"fax_number": "631-454-4163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9016 SUTPHIN BLVD",
"city": "JAMAICA",
"state": "NY",
"postal_code": "114353636",
"telephone_number": "718-523-5500",
"fax_number": "718-658-8260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HABACON",
"first_name": "OLIVIA",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-25",
"last_updated": "2013-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "142245",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00564627",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamaica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.