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General NPI Number Information
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NPI Number | 1255665915
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Entity Type | Individual
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Provider Name | JANELLE HARRISON PA
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Gender | Female
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 8268 164TH ST
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City | JAMAICA
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State | NY
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Zip | 11432-1121
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Country | US
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Telephone | 718-883-4640
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Fax |
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Provider Business Mailing Address
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Address Line | 25505 149TH RD
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City | ROSEDALE
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State | NY
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Zip | 11422-2814
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Country | US
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Telephone | 678-733-0926
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | P73130
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License Number State | NY
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