Healthcare Provider Details

I. General information

NPI: 1043305493
Provider Name (Legal Business Name): KRISTIN GAIL FLESS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

164 GLENVIEW RD
SOUTH ORANGE NJ
07079-1136
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-2924
  • Fax: 973-322-8410
Mailing address:
  • Phone: 973-763-6384
  • Fax: 973-763-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA06455300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA06455300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA06455300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: