Provider Demographics
NPI:1821026006
Name:HARRIS, ALAN I (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:I
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2958
Mailing Address - Country:US
Mailing Address - Phone:631-421-2185
Mailing Address - Fax:
Practice Address - Street 1:152 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2958
Practice Address - Country:US
Practice Address - Phone:631-421-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116565207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00416106Medicaid
NY116565OtherLICENSE NUMBER
NYC08240Medicare UPIN
NY312001Medicare ID - Type Unspecified