Healthcare Provider Details

I. General information

NPI: 1831272947
Provider Name (Legal Business Name): LYNDA SMITH HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY DEPT OF WOODHULL MEDICAL & MENTAL HEALTH CENTER
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

760 BROADWAY DEPT OF WOODHULL MEDICAL & MENTAL HEALTH CENTER
BROOKLYN NY
11206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-7638
  • Fax: 718-260-7650
Mailing address:
  • Phone: 718-260-7638
  • Fax: 718-260-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number185087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: