Provider Demographics
NPI:1518918754
Name:TIDAL EMEGENCY PHYSICIANS
Entity Type:Organization
Organization Name:TIDAL EMEGENCY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-295-6377
Mailing Address - Street 1:232 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2319
Mailing Address - Country:US
Mailing Address - Phone:800-247-8060
Mailing Address - Fax:215-957-2875
Practice Address - Street 1:1517 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-3056
Practice Address - Country:US
Practice Address - Phone:732-295-6377
Practice Address - Fax:732-206-8241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ014057Medicare ID - Type Unspecified