Provider Demographics
NPI:1558405662
Name:STEPHEN U. HARRIS, MD PLLC
Entity Type:Organization
Organization Name:STEPHEN U. HARRIS, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:U
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-9100
Mailing Address - Street 1:500 MONTAUK HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4418
Mailing Address - Country:US
Mailing Address - Phone:631-422-9100
Mailing Address - Fax:631-422-2411
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:SUITE H
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-422-9100
Practice Address - Fax:631-422-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG35141Medicare UPIN
NY10Y762Medicare PIN