Healthcare Provider Details

I. General information

NPI: 1720446834
Provider Name (Legal Business Name): MUHAMMAD HARFOUSH BVSC, DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7383 MADISON ST
WATERVILLE NY
13480-1911
US

IV. Provider business mailing address

7383 MADISON ST
WATERVILLE NY
13480-1911
US

V. Phone/Fax

Practice location:
  • Phone: 315-841-4021
  • Fax:
Mailing address:
  • Phone: 315-841-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number013020
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: