Healthcare Provider Details

I. General information

NPI: 1639193493
Provider Name (Legal Business Name): PEGGY HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/13/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E 30TH ST
NEW YORK NY
10016-8202
US

IV. Provider business mailing address

235 PARK AVE S FL 2
NEW YORK NY
10003-1405
US

V. Phone/Fax

Practice location:
  • Phone: 212-889-5544
  • Fax: 212-481-1089
Mailing address:
  • Phone: 212-614-0039
  • Fax: 212-253-9631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number229515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: