Provider Demographics
NPI:1538100854
Name:HARRIS, LLOYD (DPM)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2931
Mailing Address - Country:US
Mailing Address - Phone:908-241-1727
Mailing Address - Fax:908-241-0053
Practice Address - Street 1:2305 WOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2931
Practice Address - Country:US
Practice Address - Phone:908-241-1727
Practice Address - Fax:908-241-0053
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00139700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1437305Medicaid
NJT44813Medicare UPIN
NJ170503Medicare ID - Type Unspecified