MEDICARE: ERICA 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	012677	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LICENSE#	OTHER	NY	012677

General Provider Information

NPI Number	:	1831335090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA HARRIS PA

Provider Business Mailing Address
First Line	:	611 NORTHERN BLVD STE 150
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5207
Country	:	US
Telephone Number	:	516-325-7000
Fax Number	:	516-325-7001

Provider Business Practice Location Address
First Line	:	611 NORTHERN BLVD STE 150
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5207
Country	:	US
Telephone Number	:	516-325-7000
Fax Number	:	516-325-7001

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

Provider Enumeration Date	:	12/18/2008
Last Update Date	:	03/26/2026

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Directions to “ ERICA HARRIS PA” Practice Location

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