Provider Demographics
NPI:1245636851
Name:TOTAL RESTORATIVE HEALTH, LLC
Entity type:Organization
Organization Name:TOTAL RESTORATIVE HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:HEATHER
Authorized Official - Last Name:FISCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-884-1857
Mailing Address - Street 1:300 AVALON DR
Mailing Address - Street 2:UNIT 3274
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1012
Mailing Address - Country:US
Mailing Address - Phone:201-884-1857
Mailing Address - Fax:877-598-9776
Practice Address - Street 1:519 RIVER RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1146
Practice Address - Country:US
Practice Address - Phone:201-885-1857
Practice Address - Fax:877-598-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB079032002083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ143849Medicare UPIN