Provider Demographics
NPI:1194038695
Name:HIGHLANDS ELECTRODIAGNOSTICS
Entity Type:Organization
Organization Name:HIGHLANDS ELECTRODIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:GANGEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-751-8454
Mailing Address - Street 1:95 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07732-1955
Mailing Address - Country:US
Mailing Address - Phone:973-751-8454
Mailing Address - Fax:973-751-0071
Practice Address - Street 1:95 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07732-1955
Practice Address - Country:US
Practice Address - Phone:973-751-8454
Practice Address - Fax:973-751-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO4340200208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty