Provider Demographics
NPI:1376628727
Name:HUBERMAN, HARRIS S (MD)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:S
Last Name:HUBERMAN
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 1:180 BAY ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464-1355
Mailing Address - Country:US
Mailing Address - Phone:347-602-5575
Mailing Address - Fax:
Practice Address - Street 1:445 LENOX RD # 49
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2017
Practice Address - Country:US
Practice Address - Phone:718-270-2272
Practice Address - Fax:718-270-1985
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01577724Medicaid
NYH10016Medicare UPIN
NY72F703Medicare PIN