Provider Demographics
NPI:1639338205
Name:TESHER, HARRIS BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:BRANDON
Last Name:TESHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 GRAND AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4363
Mailing Address - Country:US
Mailing Address - Phone:201-871-3636
Mailing Address - Fax:201-871-2286
Practice Address - Street 1:200 GRAND AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4363
Practice Address - Country:US
Practice Address - Phone:201-871-3636
Practice Address - Fax:201-871-2286
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09278800207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0349178Medicaid