Individual
JONATHAN A HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 HOOPER RD, ENDWELL FAMILY PHYSICIANS LLP, ENDWELL, NY 13760-3698
(607) 754-3863
(607) 754-5697
Mailing address
415 HOOPER RD, ENDWELL, NY 13760-3698
(607) 754-3863
(607) 754-5697
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
124091
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00557617
—
NY
01
—
10031687
CDPHP
—
01
—
320946
MVP
—
01
—
3480
BLUEPOINT
—
01
—
4210330
AETNA
—
01
—
58141
GHI HMO
—
01
—
878442
AETNA HMO
—
01
—
9684882
GHI
—
01
—
NY0024397
CHAMPUS
—
Enumeration date
07/20/2006
Last updated
07/08/2007
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