Basic Information
| Provider Information | |||||||||
| NPI: | 1588674758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 S BROADWAY | ||||||||
| Address2: | GERIATRIC SERVICES, P.C. | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107014004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143765555 | ||||||||
| FaxNumber: | 9149641477 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 FERNCLIFF DR | ||||||||
| Address2: | GERIATRIC SERVICES, P.C. | ||||||||
| City: | RHINEBECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125722068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458762011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 007827 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.