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General NPI Number Information
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NPI Number | 1154549368
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Entity Type | Organization
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Legal Business Name | HARVARD STREET MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1553 BROADWAY
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City | HEWLETT
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State | NY
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Zip | 11557-1427
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Country | US
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Telephone | 516-374-8666
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Fax |
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Provider Business Mailing Address
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Address Line | 1553 BROADWAY
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City | HEWLETT
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State | NY
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Zip | 11557-1427
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Country | US
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Telephone | 516-374-1677
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Fax | 516-374-8666
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | SHARON AZMON
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Credential |
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Telephone | 516-374-1677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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