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General NPI Number Information
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NPI Number | 1922252048
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Entity Type | Individual
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Provider Name | HARRIS BOB BRODY HMD, CN, HMD
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Gender | Male
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 655 WEST COUNTY LINE RD.
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City | HATBORO
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State | PA
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Zip | 19040
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Country | US
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Telephone | 215-443-9990
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Fax | 215-443-9957
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Provider Business Mailing Address
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Address Line | 655 WEST COUNTY LINE RD.
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City | HATBORO
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State | PA
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Zip | 19040-1302
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Country | US
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Telephone | 215-443-9990
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Fax | 215-443-9957
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 003749-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CQ001369L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | CL022136L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | NAT173
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 200001706104
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License Number State | NC
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