Provider Demographics
NPI:1497821029
Name:HARRISON, MALIA N (RPA C)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:N
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RPA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MADISON AVENUE
Mailing Address - Street 2:FLOOR 6 COMMUNITY HEALTHCARE NETWORK INC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:1167 NOSTRAND AVENUE
Practice Address - Street 2:CARIBBEAN HOUSE HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225
Practice Address - Country:US
Practice Address - Phone:718-778-0198
Practice Address - Fax:718-221-8169
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331978Medicare PIN
NY331946Medicare PIN
NY331954Medicare PIN
NY331944Medicare PIN
Q61747Medicare UPIN
NY00695941Medicaid
NY331947Medicare PIN
NY331943Medicare PIN
NY331952Medicare PIN