Provider Demographics
NPI:1861758864
Name:HARRIS, MICHAEL ELI (MD , MPH)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELI
Last Name:HARRIS
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Gender:M
Credentials:MD , MPH
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Mailing Address - Street 1:10211 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2331
Mailing Address - Country:US
Mailing Address - Phone:718-898-5200
Mailing Address - Fax:718-898-1251
Practice Address - Street 1:10211 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2331
Practice Address - Country:US
Practice Address - Phone:718-898-5200
Practice Address - Fax:718-898-1251
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2016-05-17
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Provider Licenses
StateLicense IDTaxonomies
NY280075208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04254564Medicaid