Provider Demographics
NPI:1487727210
Name:HARRIS, DENA ELLEN (MD)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:ELLEN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 WEST BROADWAY
Mailing Address - Street 2:2ND FLOOR SOUTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:212-941-0011
Mailing Address - Fax:212-941-5977
Practice Address - Street 1:430 WEST BROADWAY
Practice Address - Street 2:2ND FLOOR SOUTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012
Practice Address - Country:US
Practice Address - Phone:212-941-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134134207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09556Medicare UPIN
39A961Medicare ID - Type Unspecified