Provider Demographics
NPI:1588674758
Name:HARRIS, MICHAEL P (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:69 S BROADWAY
Mailing Address - Street 2:GERIATRIC SERVICES, P.C.
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4004
Mailing Address - Country:US
Mailing Address - Phone:914-376-5555
Mailing Address - Fax:914-964-1477
Practice Address - Street 1:21 FERNCLIFF DR
Practice Address - Street 2:GERIATRIC SERVICES, P.C.
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-2068
Practice Address - Country:US
Practice Address - Phone:845-876-2011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant