Healthcare Provider Details

I. General information

NPI: 1528298817
Provider Name (Legal Business Name): INTENSIVISTS AT HIGHLAND PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAY AVENUE
MONCLAIR NJ
07042
US

IV. Provider business mailing address

66 WEST GILBERT STREET 2ND FLOOR
RED BANK NJ
07701-4918
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-6000
  • Fax:
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0207870
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: JOSEPH J CALABRO
Title or Position: PRESIDENT
Credential: DO
Phone: 732-212-0060