Healthcare Provider Details

I. General information

NPI: 1831410596
Provider Name (Legal Business Name): SCOTT S HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD STE 100
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD STE 100
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-482-3223
  • Fax: 516-482-2433
Mailing address:
  • Phone: 516-482-3223
  • Fax: 516-482-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number277159-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: