Provider Demographics
NPI:1336476464
Name:WILLIAM, HARISSON JUDE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:HARISSON
Middle Name:JUDE
Last Name:WILLIAM
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ORMONDE BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3041
Mailing Address - Country:US
Mailing Address - Phone:516-547-6772
Mailing Address - Fax:
Practice Address - Street 1:150 ORMONDE BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3041
Practice Address - Country:US
Practice Address - Phone:516-547-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY523915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse