MEDICARE: ISIDORA HARRISON

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	332BC3200X	Customized Equipment (DME)	120220677797	NY

General Provider Information

NPI Number	:	1861263626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISIDORA HARRISON

Provider Business Mailing Address
First Line	:	120 ELGAR PL APT 29H
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5109
Country	:	US
Telephone Number	:	718-515-5800
Fax Number	:

Provider Business Practice Location Address
First Line	:	874 E 231ST ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-4492
Country	:	US
Telephone Number	:	717-515-5800
Fax Number	:

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

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	01/10/2024

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Directions to “ ISIDORA HARRISON ” Practice Location

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