Basic Information
| Provider Information | |||||||||
| NPI: | 1871150193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR VIEW MEDICAL SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 HIGHLANDS BLVD # 9 | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117772320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316867809 | ||||||||
| FaxNumber: | 6316867972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 ROUTE 112 BLDG 6 | ||||||||
| Address2: | |||||||||
| City: | PORT JEFFERSON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117768054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316867890 | ||||||||
| FaxNumber: | 6319787625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2019 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | DONNELLY | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | EVE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PHYSICIAN CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 6316867603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.