Healthcare Provider Details

I. General information

NPI: 1124593892
Provider Name (Legal Business Name): ELIZABETH HARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8684 15TH AVE
BROOKLYN NY
11228-3409
US

IV. Provider business mailing address

3052 BRIGHTON 1ST ST APT 2B
BROOKLYN NY
11235-8089
US

V. Phone/Fax

Practice location:
  • Phone: 718-232-0703
  • Fax:
Mailing address:
  • Phone: 401-787-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number674631-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342716-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: