Provider Demographics
NPI:1245361112
Name:HARRISON, LEONARD R JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:R
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 1:133 EAST 73RD STREET
Mailing Address - Street 2:#101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-628-7772
Mailing Address - Fax:212-628-0746
Practice Address - Street 1:133 EAST 73RD STREET
Practice Address - Street 2:#101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-628-7772
Practice Address - Fax:212-628-0746
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
553027OtherAETNA
64692OtherEMPIRE
P1229121OtherOXFORD
C11858Medicare UPIN
64692OtherEMPIRE