Provider Demographics
NPI:1790925550
Name:HARRIS, EDWARD MICHAEL (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:MICHAEL
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:409 W 145TH ST
Mailing Address - Street 2:503
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-5200
Mailing Address - Country:US
Mailing Address - Phone:917-374-1178
Mailing Address - Fax:212-281-9715
Practice Address - Street 1:409 W 145TH ST
Practice Address - Street 2:503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-5200
Practice Address - Country:US
Practice Address - Phone:917-374-1178
Practice Address - Fax:212-281-9715
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY481003372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider