Organization
TIDAL EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL H. HARRIS MD (ENROLLMENT SPECIALIST)
(800) 247-8060
Entity
Organization
Contact information
Practice address
425 JACK MARTIN BLVD, BRICK, NJ 08724-7732
(732) 840-3380
(732) 458-3745
Mailing address
232 LAKESIDE DR, HORSHAM, PA 19044-2319
(800) 247-8060
(215) 957-2875
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
05/12/2006
Last updated
08/22/2020
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