Provider Demographics
NPI:1194937805
Name:HAROON, SAMEERA N (M,D)
Entity type:Individual
Prefix:
First Name:SAMEERA
Middle Name:N
Last Name:HAROON
Suffix:
Gender:F
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10414 113TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2506
Mailing Address - Country:US
Mailing Address - Phone:718-835-2254
Mailing Address - Fax:718-303-0763
Practice Address - Street 1:10414 113TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-2506
Practice Address - Country:US
Practice Address - Phone:718-835-2254
Practice Address - Fax:718-303-0763
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241068208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02886139Medicaid