Physician Compare National (NPI:1396804431)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1396804431
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698959013
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140731002327
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HARRISON
	Individual professional last name
Provider First Name	KEVIN
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PREVENTATIVE MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PREVENTATIVE MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	290 COMMUNITY DR
	Group Practice or individual's line 1 address
City	GREAT NECK
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	110215504
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5164871902
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y