Provider Demographics
NPI:1235813262
Name:HARRISON, HOWARD DALSTON JR (MD)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:DALSTON
Last Name:HARRISON
Suffix:JR
Gender:M
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:PO BOX 4075
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11531-4075
Mailing Address - Country:US
Mailing Address - Phone:347-357-8048
Mailing Address - Fax:
Practice Address - Street 1:11845 NASHVILLE BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1919
Practice Address - Country:US
Practice Address - Phone:347-357-8048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic