Provider Demographics
NPI:1114146172
Name:NEW YORK GENERAL SURGERY, PLLC
Entity Type:Organization
Organization Name:NEW YORK GENERAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-861-2217
Mailing Address - Street 1:1160 5TH AVE OFC 105
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6932
Mailing Address - Country:US
Mailing Address - Phone:212-861-2217
Mailing Address - Fax:212-861-1801
Practice Address - Street 1:1160 5TH AVE OFC 105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6932
Practice Address - Country:US
Practice Address - Phone:212-861-2217
Practice Address - Fax:212-861-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1328172086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B79260Medicare UPIN
75A731Medicare ID - Type Unspecified