Provider Demographics
NPI:1023229242
Name:HARRIS, ELIZABETH EDITH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:EDITH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E 92ND ST
Mailing Address - Street 2:APT 3W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5400
Mailing Address - Country:US
Mailing Address - Phone:443-935-9221
Mailing Address - Fax:
Practice Address - Street 1:1621 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2604
Practice Address - Country:US
Practice Address - Phone:718-405-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY257507207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program