Provider Demographics
NPI:1104920255
Name:HARARAH, ANDREW M (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:HARARAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:357 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2748
Mailing Address - Country:US
Mailing Address - Phone:631-789-7900
Mailing Address - Fax:631-608-8492
Practice Address - Street 1:357 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2748
Practice Address - Country:US
Practice Address - Phone:631-789-7900
Practice Address - Fax:631-608-8492
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY213353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH21222Medicare UPIN
NY5167D1Medicare ID - Type Unspecified