NPIMap

Organization Active NPI

Tidal Emergency Physicians LLC

  • Emergency Medicine Physician
  • Neptune, NJ
National Provider Identifier
1649222407
Registry record updated Dec 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
TIDAL EMERGENCY PHYSICIANS LLC
Practice address
1945 Corlies Ave
Neptune, NJ 07753-4859
Phone
(732) 776-4203
NPI assigned
May 17, 2006
Last updated
Dec 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Russell H. Harris,, MDNPI 1598714800
Title
President
Phone
(469) 401-2386

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

1945 Corlies Ave
Neptune, NJ 07753-4859

Mailing address

13737 Noel Rd
Ste 1600
Dallas, TX 75240-1331
Phone (469) 401-2386

Other identifiers 1

IdentifierTypeStateIssuer
7660103MedicaidNJ

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1517 Richmond Ave
Point Pleasant Boro, NJ 08742
Phone (732) 295-6377

Practitioners & affiliated clinicians

Practitioners 126

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 126

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387843200000",
    "number": "1649222407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13737 NOEL RD",
            "address_2": "STE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752401331",
            "telephone_number": "469-401-2386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 CORLIES AVE",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077534859",
            "telephone_number": "732-776-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDAL EMERGENCY PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2013-12-24",
        "status": "A",
        "authorized_official_last_name": "HARRIS,",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "469-401-2386",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7660103",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Neptune, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.