Healthcare Provider Details

I. General information

NPI: 1982164372
Provider Name (Legal Business Name): JOSHUA D HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 ENGLE ST
ENGLEWOOD NJ
07631-1808
US

IV. Provider business mailing address

6 RESEARCH DR STE 105
SHELTON CT
06484-6296
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-3689
  • Fax:
Mailing address:
  • Phone: 203-210-6340
  • Fax: 203-502-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number77740
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA12876600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: