1861492027 NPI number — KENNETH B HARRIS MD

Table of content: KENNETH B HARRIS MD (NPI 1861492027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861492027 NPI number — KENNETH B HARRIS MD

Organization/Personal Information

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

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:
1861492027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 NEPTUNE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-775-5300
Provider Business Mailing Address Fax Number:
732-775-1737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 NEPTUNE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-775-5300
Provider Business Practice Location Address Fax Number:
732-775-1737
Provider Enumeration Date:
07/28/2005

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: 207RC0000X , with the licence number:  25MA07377200 , 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: 1034358 . This is a "MERCY HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2227377 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8880000 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2654381 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 110236137 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2945805 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K2616 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 501P31 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9149071103 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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