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General NPI Number Information
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NPI Number | 1689529851
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Entity Type | Individual
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Provider Name | BETHANY S HARRIS PA
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Gender | Female
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1680 ROUTE 23 STE 180
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City | WAYNE
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State | NJ
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Zip | 07470-7522
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Country | US
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Telephone | 866-569-7049
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WESMONT DR
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City | WOOD RIDGE
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State | NJ
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Zip | 07075-2150
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Country | US
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Telephone | 615-636-7157
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MO00996800
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License Number State | NJ
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