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General NPI Number Information
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NPI Number | 1326133646
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Entity Type | Individual
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Provider Name | HARITON KOUSOUROU M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 45 ROUTE 25A SUITE C
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City | SHOREHAM
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State | NY
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Zip | 11786-1389
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Country | US
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Telephone | 631-821-2626
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Fax | 631-744-1627
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Provider Business Mailing Address
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Address Line | 452 HEALTH PARKWAY SUITE F
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City | PAW PAW
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State | MI
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Zip | 49079
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Country | US
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Telephone | 269-655-3080
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Fax | 269-655-0761
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 156800
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License Number State | NY
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