Healthcare Provider Details

I. General information

NPI: 1881817377
Provider Name (Legal Business Name): HARRIS ANESTHESIA ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 OLD MONTICELLO RD
FERNDALE NY
12734-5224
US

IV. Provider business mailing address

PO BOX 284
HARRIS NY
12742-0284
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-0078
  • Fax: 845-292-3244
Mailing address:
  • Phone: 845-794-3300
  • Fax: 845-791-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. HUSSEIN OMAR
Title or Position: DIRECTOR
Credential: MD
Phone: 845-794-3300