Provider Demographics
NPI:1194904672
Name:HARRISON, JOLENE YVETTE (MS RD CDN)
Entity type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:YVETTE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BROAD ST
Mailing Address - Street 2:2700
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-1923
Mailing Address - Country:US
Mailing Address - Phone:201-245-4975
Mailing Address - Fax:
Practice Address - Street 1:15 BROAD ST
Practice Address - Street 2:2700
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-1923
Practice Address - Country:US
Practice Address - Phone:201-245-4975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48006347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered