Provider Demographics
NPI:1861492027
Name:HARRIS, KENNETH B (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:B
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 1:444 NEPTUNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4144
Mailing Address - Country:US
Mailing Address - Phone:732-775-5300
Mailing Address - Fax:732-775-1737
Practice Address - Street 1:444 NEPTUNE BLVD
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4144
Practice Address - Country:US
Practice Address - Phone:732-775-5300
Practice Address - Fax:732-775-1737
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07377200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1034358OtherMERCY HEALTH
NJ2227377OtherUNITED HEALTHCARE
NJ8880000Medicaid
NJP2654381OtherOXFORD
NJ110236137OtherRAILROAD MEDICARE
NJ2945805OtherAETNA
NJ2K2616OtherHEALTH NET
NJ501P31OtherEMPIRE BLUE CROSS
NJ9149071103OtherCIGNA
NJ1034358OtherMERCY HEALTH
NJ2945805OtherAETNA