Provider Demographics
NPI:1538191697
Name:HAIMOWITZ, IRA L (DO)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:L
Last Name:HAIMOWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BEY LEA ROAD
Mailing Address - Street 2:SUITE B203
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-341-0720
Mailing Address - Fax:732-244-6842
Practice Address - Street 1:40 BEY LEA ROAD
Practice Address - Street 2:SUITE B203
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-341-0720
Practice Address - Fax:732-244-6842
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05127800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2985OtherHEALTHNET
01000166400OtherAMERICHOICE
0717177000OtherAMERIHEALTH HMO
11482OtherAETNA HMO
VP002OtherOXFORD
31K613OtherWELL CHOICE
4372405OtherAETNA PPO
15484OtherUNIVERSITY
2699919OtherGHI
340Y72OtherWELL CHOICE
PL400013OtherBCBS PPO
1018799OtherHORIZON NJ HEALTH
52152OtherCIGNA HMO
00243OtherQUALCARE
038575OtherAMERIHEALTH PPO
1018796OtherHORIZON NJ HEALTH
1018797OtherHORIZON NJ HEALTH
10658011OtherCAQH