MEDICARE: BETHANY S HARRIS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	25MO00996800	NJ

General Provider Information

NPI Number	:	1689529851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY S HARRIS PA

Provider Business Mailing Address
First Line	:	104 WESMONT DR
Second Line	:
City	:	WOOD RIDGE
State	:	NJ
Zip	:	07075-2150
Country	:	US
Telephone Number	:	615-636-7157
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 ROUTE 23 STE 180
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-7522
Country	:	US
Telephone Number	:	866-569-7049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ BETHANY S HARRIS PA” Practice Location

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