Provider Demographics
NPI:1093734139
Name:FLOCKHART, HAROLD (NP)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:
Last Name:FLOCKHART
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1149
Mailing Address - Country:US
Mailing Address - Phone:631-689-0646
Mailing Address - Fax:
Practice Address - Street 1:12 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1149
Practice Address - Country:US
Practice Address - Phone:631-689-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303563-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0999G1Medicare ID - Type Unspecified