Healthcare Provider Details

I. General information

NPI: 1366328197
Provider Name (Legal Business Name): HARRISON O IREDIA APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COMMERCE DR STE 135
CRANFORD NJ
07016-3614
US

IV. Provider business mailing address

20 COMMERCE DR STE 135
CRANFORD NJ
07016-3614
US

V. Phone/Fax

Practice location:
  • Phone: 848-304-1631
  • Fax: 949-849-9962
Mailing address:
  • Phone: 848-304-1631
  • Fax: 949-849-9962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15373500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: