Healthcare Provider Details

I. General information

NPI: 1295713634
Provider Name (Legal Business Name): HARRIET E MCGURK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 168TH ST CH 517 CHILDRENS HOSP OF NY DEPT PEDIATRICS
NYC NY
10032
US

IV. Provider business mailing address

630 W 168TH ST CH 517 CHILDRENS HOSPITAL OF NY DEPT PEDIATRICS
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-3060
  • Fax: 212-342-6010
Mailing address:
  • Phone: 212-342-3060
  • Fax: 212-342-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number121259
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: