Basic Information
| Provider Information | |||||||||
| NPI: | 1881817377 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARRIS ANESTHESIA ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 284 | ||||||||
| Address2: | |||||||||
| City: | HARRIS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127420284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457943300 | ||||||||
| FaxNumber: | 8457917416 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 OLD MONTICELLO RD | ||||||||
| Address2: | |||||||||
| City: | FERNDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127345224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452920078 | ||||||||
| FaxNumber: | 8452923244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OMAR | ||||||||
| AuthorizedOfficialFirstName: | HUSSEIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8457943300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 01624684 | 05 | NY | MEDICAID |