Healthcare Provider Details

I. General information

NPI: 1104892546
Provider Name (Legal Business Name): RICHARD HARRIS FLYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 PARK AVE
VERONA NJ
07044-2440
US

IV. Provider business mailing address

36 PARK AVE
VERONA NJ
07044-2440
US

V. Phone/Fax

Practice location:
  • Phone: 973-239-7001
  • Fax: 973-239-8867
Mailing address:
  • Phone: 973-239-7001
  • Fax: 973-239-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03715500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: