Provider Demographics
NPI:1851898381
Name:BANNETT, HARRISON PHILLIP (DO)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:PHILLIP
Last Name:BANNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:620 NORTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1795
Mailing Address - Country:US
Mailing Address - Phone:856-853-5554
Mailing Address - Fax:856-853-5650
Practice Address - Street 1:620 NORTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1795
Practice Address - Country:US
Practice Address - Phone:856-853-5554
Practice Address - Fax:856-853-5650
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB11890500207WX0009X, 207W00000X
CT71130207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist