Provider Demographics
NPI:1982843868
Name:HARRIS, JONATHAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
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 1:331 E 58TH ST
Mailing Address - Street 2:5-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2217
Mailing Address - Country:US
Mailing Address - Phone:646-472-0023
Mailing Address - Fax:
Practice Address - Street 1:331 E 58TH ST
Practice Address - Street 2:5-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2217
Practice Address - Country:US
Practice Address - Phone:646-472-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246524207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology