Provider Demographics
NPI:1699024273
Name:HARRIS, PENINA MALKA (MS-SED)
Entity Type:Individual
Prefix:MRS
First Name:PENINA
Middle Name:MALKA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS-SED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14753 76TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3121
Mailing Address - Country:US
Mailing Address - Phone:414-737-0951
Mailing Address - Fax:
Practice Address - Street 1:14753 76TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3121
Practice Address - Country:US
Practice Address - Phone:414-737-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1734244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist