Provider Demographics
NPI:1225066533
Name:HARRIS, ROBERT MILTON (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MILTON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1124
Mailing Address - Country:US
Mailing Address - Phone:973-614-0277
Mailing Address - Fax:
Practice Address - Street 1:185 CEDAR LN
Practice Address - Street 2:STE L1
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4303
Practice Address - Country:US
Practice Address - Phone:201-928-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03720000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0280801Medicaid
D19248Medicare UPIN
HA1637Medicare ID - Type Unspecified