1427024975 NPI number — BRENDA HARRIS MD

Table of content: BRENDA HARRIS MD (NPI 1427024975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427024975 NPI number — BRENDA HARRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
BRENDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427024975
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 NEW PROVIDENCE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAINSIDE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07092-2590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-301-5491
Provider Business Mailing Address Fax Number:
908-301-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 NEW PROVIDENCE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAINSIDE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07092-2590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-301-5491
Provider Business Practice Location Address Fax Number:
908-301-5456
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0008X , with the licence number:  25MA04680900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0107791000 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1145039 . This is a "AETNA HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 221487148-088 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K3746 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 67931 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4577364 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: S51B01 . This is a "EMPIRE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 13902 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60020933 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3637710 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com