Healthcare Provider Details

I. General information

NPI: 1033444021
Provider Name (Legal Business Name): HIGH CREST MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FAIRFIELD RD
FAIRFIELD NJ
07004-2414
US

IV. Provider business mailing address

50 FAIRFIELD RD
FAIRFIELD NJ
07004-2414
US

V. Phone/Fax

Practice location:
  • Phone: 973-808-5550
  • Fax: 973-808-5999
Mailing address:
  • Phone: 973-808-5550
  • Fax: 973-808-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE L EVANS II
Title or Position: PHYSICIAN
Credential: MD
Phone: 973-808-5550