Healthcare Provider Details

I. General information

NPI: 1255230421
Provider Name (Legal Business Name): PLATFORM MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 RIVER RD STE 204
SUMMIT NJ
07901-1421
US

IV. Provider business mailing address

23 GLENBROOK RD
MORRIS PLAINS NJ
07950-2206
US

V. Phone/Fax

Practice location:
  • Phone: 908-516-0055
  • Fax: 908-516-0066
Mailing address:
  • Phone: 908-516-0055
  • Fax: 908-516-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL RICHARD
Title or Position: SURGEON
Credential: MD
Phone: 919-599-9778