Provider Demographics
NPI:1275146615
Name:HARRISON, ELISE GENEE (RDN)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:GENEE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13830 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-4804
Mailing Address - Country:US
Mailing Address - Phone:717-657-3013
Mailing Address - Fax:
Practice Address - Street 1:1 CROSS ISLAND PLZ STE 229C
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1400
Practice Address - Country:US
Practice Address - Phone:855-958-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered