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: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 NEW JERSEY AVE
WILDWOOD CREST NJ
08260-1216
US

IV. Provider business mailing address

6410 NEW JERSEY AVE
WILDWOOD CREST NJ
08260-1216
US

V. Phone/Fax

Practice location:
  • Phone: 609-523-1331
  • Fax:
Mailing address:
  • Phone: 609-523-1331
  • Fax: 609-569-7070

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: