Provider Demographics
NPI:1619156148
Name:HAREL, MIRIAM M (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:M
Last Name:HAREL
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 1:247 ROUTE 100 STE 1002
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3231
Mailing Address - Country:US
Mailing Address - Phone:914-962-8290
Mailing Address - Fax:914-962-8851
Practice Address - Street 1:100 SIMSBURY RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3793
Practice Address - Country:US
Practice Address - Phone:860-409-0413
Practice Address - Fax:860-499-5418
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT0512122088P0231X, 208800000X
NY2867052088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208800000XAllopathic & Osteopathic PhysiciansUrology