Provider Demographics
NPI:1902412968
Name:HARBIN, ELIZABETH JANE
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JANE
Last Name:HARBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 CURTIS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2611
Mailing Address - Country:US
Mailing Address - Phone:347-884-1399
Mailing Address - Fax:
Practice Address - Street 1:810 CURTIS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2611
Practice Address - Country:US
Practice Address - Phone:347-884-1399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY705612163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice