Provider Demographics
NPI:1508216185
Name:PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:HARDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-286-3572
Mailing Address - Street 1:2 ACADEMY LN
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2702
Mailing Address - Country:US
Mailing Address - Phone:631-286-3572
Mailing Address - Fax:
Practice Address - Street 1:2 ACADEMY LN
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2702
Practice Address - Country:US
Practice Address - Phone:631-286-3572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0704871261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0704871OtherINDIVIDUAL PRACTITIONER