Healthcare Provider Details

I. General information

NPI: 1962641746
Provider Name (Legal Business Name): EMILY DEBORAH HARRIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2150
  • Fax: 718-741-2237
Mailing address:
  • Phone: 718-741-2150
  • Fax: 718-741-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number220046
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: