Provider Demographics
NPI:1366328197
Name:IREDIA, HARRRISON O (APN)
Entity type:Individual
Prefix:
First Name:HARRRISON
Middle Name:O
Last Name:IREDIA
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WOOD THRUSH AVE
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5275
Mailing Address - Country:US
Mailing Address - Phone:862-224-5279
Mailing Address - Fax:
Practice Address - Street 1:23 WOOD THRUSH AVE
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5275
Practice Address - Country:US
Practice Address - Phone:862-224-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15373500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health