Individual
HARIS BASIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1250 S CEDAR CREST BLVD STE 205, ALLENTOWN, PA 18103-6271
(610) 402-9116
Mailing address
1735 ASHLEY HALL RD APT 122, CHARLESTON, SC 29407-4005
(717) 645-0647
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA067100
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/13/2024
Last updated
09/23/2025
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