Basic Information
| Provider Information | |||||||||
| NPI: | 1699744037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076313703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018710136 | ||||||||
| FaxNumber: | 2014877340 | ||||||||
| Practice Location | |||||||||
| Address1: | HACKENSACK UNIVERSITY MEDICAL CENTER, PC116 | ||||||||
| Address2: | 30 PROSPECT AVE | ||||||||
| City: | HACKENSACK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5519965437 | ||||||||
| FaxNumber: | 2014877340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/06/2013 | ||||||||
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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 | 2080P0207X | 25MA04551900 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.