Provider Demographics
NPI:1376713073
Name:HIGH CREST INTEGRATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:HIGH CREST INTEGRATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CATALANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-808-5550
Mailing Address - Street 1:50 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-2414
Mailing Address - Country:US
Mailing Address - Phone:973-808-5550
Mailing Address - Fax:973-808-5999
Practice Address - Street 1:50 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-2414
Practice Address - Country:US
Practice Address - Phone:973-808-5550
Practice Address - Fax:973-808-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03264111NS0005X
NJMA062525208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty