Provider Demographics
NPI:1265665616
Name:FARRELL HARRIS, KATHERINE C (RD, CDN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:C
Last Name:FARRELL HARRIS
Suffix:
Gender:F
Credentials:RD, CDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ADVANTAGECARE PHYSICIANS, PC
Mailing Address - Street 2:55 WATER STREET 2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:52 DUANE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1207
Practice Address - Country:US
Practice Address - Phone:646-680-4227
Practice Address - Fax:516-542-5556
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20510119163WD0400X
NY005474133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03459592Medicaid
NY000600027483OtherHEALTH PLUS
NY03459592Medicaid