Provider Demographics
NPI:1699904565
Name:HARRISON, AUGUSTA ORR (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:ORR
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:BOX 1259
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:917-544-6766
Mailing Address - Fax:212-202-4713
Practice Address - Street 1:17 E 102ND ST
Practice Address - Street 2:5TH FLOOR, EAST TOWER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5204
Practice Address - Country:US
Practice Address - Phone:212-241-2475
Practice Address - Fax:212-202-4713
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006730133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP4030503OtherOXFORD