Provider Demographics
NPI:1912561614
Name:HARRIS, ADA M
Entity Type:Individual
Prefix:MS
First Name:ADA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 SADDLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4828
Mailing Address - Country:US
Mailing Address - Phone:516-216-0216
Mailing Address - Fax:
Practice Address - Street 1:2103 SADDLE ROCK RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4828
Practice Address - Country:US
Practice Address - Phone:516-216-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist