MEDICARE: MALIA N HARRISON RPA C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010550	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497821029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIA N HARRISON RPA C

Provider Business Mailing Address
First Line	:	79 MADISON AVENUE
Second Line	:	FLOOR 6 COMMUNITY HEALTHCARE NETWORK INC
City	:	NEW YORK
State	:	NY
Zip	:	10016
Country	:	US
Telephone Number	:	212-545-2400
Fax Number	:	646-312-0481

Provider Business Practice Location Address
First Line	:	1167 NOSTRAND AVENUE
Second Line	:	CARIBBEAN HOUSE HEALTH CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11225
Country	:	US
Telephone Number	:	718-778-0198
Fax Number	:	718-221-8169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/14/2008

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