Provider Demographics
NPI:1427024975
Name:HARRIS, BRENDA (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NEW PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2590
Mailing Address - Country:US
Mailing Address - Phone:908-301-5491
Mailing Address - Fax:908-301-5456
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-301-5491
Practice Address - Fax:908-301-5456
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA046809002080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0107791000OtherAMERICHOICE
NJ1145039OtherAETNA HEALTHCARE
NJ221487148-088OtherQUALCARE
NJ3K3746OtherHEALTHNET
NJ67931OtherAMERIGROUP
NJ4577364OtherCIGNA HEALTHCARE
NJS51B01OtherEMPIRE
NJ13902OtherUNIVERSITY HEALTH PLANS
NJ60020933OtherHORIZON NJ HEALTH
NJP3637710OtherOXFORD HEALTH PLANS
NJ67931OtherAMERIGROUP