=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609939503
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRIS S. HAUSEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 370 S OYSTER BAY RD
-----------------------------------------------------
City | HICKSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11801-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-931-2525
-----------------------------------------------------
Fax | 516-931-2595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 370 S OYSTER BAY RD
-----------------------------------------------------
City | HICKSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11801-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-931-2525
-----------------------------------------------------
Fax | 516-931-2595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 190037
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------