Provider Demographics
NPI:1154549368
Name:HARVARD STREET MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:HARVARD STREET MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-374-1677
Mailing Address - Street 1:1553 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1427
Mailing Address - Country:US
Mailing Address - Phone:516-374-1677
Mailing Address - Fax:516-374-8666
Practice Address - Street 1:1553 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1427
Practice Address - Country:US
Practice Address - Phone:516-374-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW86381Medicare PIN