Healthcare Provider Details

I. General information

NPI: 1750414637
Provider Name (Legal Business Name): VICTORIA HARRISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST BOX 142
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-1500
  • Fax:
Mailing address:
  • Phone: 212-746-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number237995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: