Healthcare Provider Details

I. General information

NPI: 1689612822
Provider Name (Legal Business Name): RANDYE F HURON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

110 DOWNEY DR
TENAFLY NJ
07670-3004
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-5353
  • Fax:
Mailing address:
  • Phone: 201-996-5202
  • Fax: 201-489-1892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number25MA05233400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: