1407995301 NPI number — PHILIP HARRIS MD PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407995301 NPI number — PHILIP HARRIS MD PC

Organization/Personal Information

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

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:
1407995301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2031 FOREST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATEN IS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-876-6220
Provider Business Mailing Address Fax Number:
718-876-5969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BROOKDALE PLAZA
Provider Second Line Business Practice Location Address:
ROOM 344
Provider Business Practice Location Address City Name:
BKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-876-6220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-876-6220

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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