MEDICARE: JAZMINE HARRIS MD

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	208000000X	Pediatrics Physician	MA073399	NJ

General Provider Information

NPI Number	:	1881693844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMINE HARRIS MD

Provider Business Mailing Address
First Line	:	53 S LAUREL ST
Second Line	:	2ND FLOOR
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1946
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-453-8495

Provider Business Practice Location Address
First Line	:	53 S LAUREL ST
Second Line	:	2ND FLOOR
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1946
Country	:	US
Telephone Number	:	856-451-4700
Fax Number	:	856-453-8495

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/16/2012

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