Provider Demographics
NPI:1427833169
Name:HARRISON, JOSEPH CEPHAS JR
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CEPHAS
Last Name:HARRISON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SLATE CREEK DR APT 10
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2918
Mailing Address - Country:US
Mailing Address - Phone:716-391-7777
Mailing Address - Fax:
Practice Address - Street 1:27 SLATE CREEK DR APT 10
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2918
Practice Address - Country:US
Practice Address - Phone:716-391-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417884100172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver