Healthcare Provider Details

I. General information

NPI: 1629539259
Provider Name (Legal Business Name): CHAD LAWRENCE HARRIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 DELANCEY ST
NEW YORK NY
10002-3202
US

IV. Provider business mailing address

108 DELANCEY ST
NEW YORK NY
10002-3202
US

V. Phone/Fax

Practice location:
  • Phone: 212-677-2157
  • Fax: 212-982-2792
Mailing address:
  • Phone: 212-677-2157
  • Fax: 212-982-2792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS19608
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number333148
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS19608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: