MEDICARE: DR. JONATHAN SAMUEL 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	207R00000X	Internal Medicine Physician	215283	NY

General Provider Information

NPI Number	:	1972510626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN SAMUEL HARRIS MD

Provider Business Mailing Address
First Line	:	1 HOLLY LN
Second Line	:
City	:	RYE BROOK
State	:	NY
Zip	:	10573-1018
Country	:	US
Telephone Number	:	914-934-2473
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 UNIONPORT RD
Second Line	:	PARK SOUTH MEDICAL
City	:	BRONX
State	:	NY
Zip	:	10462
Country	:	US
Telephone Number	:	718-892-2201
Fax Number	:	718-828-9663

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	05/14/2008

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