Provider Demographics
NPI:1013977453
Name:HARRIS, BRIAN E (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
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 1:32 PARK HILL TER
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1917
Mailing Address - Country:US
Mailing Address - Phone:732-284-1964
Mailing Address - Fax:
Practice Address - Street 1:32 PARK HILL TER
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-1917
Practice Address - Country:US
Practice Address - Phone:732-284-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04733100207R00000X
NY152013207P00000X
NJ47331207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00624286OtherRAILROAD MEDICARE
NJ0652105Medicaid
NJ457660UWYMedicare PIN
NJP00624286OtherRAILROAD MEDICARE
NJE22030Medicare UPIN
NJ457660DPSMedicare ID - Type Unspecified