Healthcare Provider Details

I. General information

NPI: 1699137398
Provider Name (Legal Business Name): KATIE FLUHARTY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE LERANIAN PA-C

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVENUE BUILDING 500 SUITE 501
EGG HARBOR TOWNSHIP NJ
08234
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVENUE BUILDING 500 SUITE 501
EGG HARBOR TOWNSHIP NJ
08234
US

V. Phone/Fax

Practice location:
  • Phone: 609-833-4410
  • Fax: 609-445-4241
Mailing address:
  • Phone: 609-833-4410
  • Fax: 609-445-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP0039000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: