Provider Demographics
NPI:1962402677
Name:HARRIS, STEPHEN U (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:U
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 MONTAUK HWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4418
Mailing Address - Country:US
Mailing Address - Phone:631-422-9100
Mailing Address - Fax:631-422-2411
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:SUITE H
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-422-9100
Practice Address - Fax:631-422-2411
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY187253-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00279602OtherTRAVELERS MEDICARE
G35141Medicare UPIN
NY10Y762Medicare ID - Type Unspecified