Healthcare Provider Details

I. General information

NPI: 1265665616
Provider Name (Legal Business Name): KATHERINE C FARRELL HARRIS R.D., C.D.N., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 DUANE ST
NEW YORK NY
10007-1207
US

IV. Provider business mailing address

ADVANTAGECARE PHYSICIANS, PC 55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 646-680-4227
  • Fax: 516-542-5556
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number20510119
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number005474
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: