Provider Demographics
NPI:1639752173
Name:HARIRI, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:HARIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 E 95TH ST APT 11G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2562
Mailing Address - Country:US
Mailing Address - Phone:443-204-3739
Mailing Address - Fax:
Practice Address - Street 1:280 N BEDFORD RD
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1141
Practice Address - Country:US
Practice Address - Phone:914-241-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02995400122300000X
NY063135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist