Healthcare Provider Details

I. General information

NPI: 1497821029
Provider Name (Legal Business Name): MALIA N HARRISON RPA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 NOSTRAND AVENUE CARIBBEAN HOUSE HEALTH CENTER
BROOKLYN NY
11225
US

IV. Provider business mailing address

79 MADISON AVENUE FLOOR 6 COMMUNITY HEALTHCARE NETWORK INC
NEW YORK NY
10016
US

V. Phone/Fax

Practice location:
  • Phone: 718-778-0198
  • Fax: 718-221-8169
Mailing address:
  • Phone: 212-545-2400
  • Fax: 646-312-0481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: