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General NPI Number Information
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NPI Number | 1245636851
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Entity Type | Organization
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Legal Business Name | TOTAL RESTORATIVE HEALTH, LLC
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 11/10/2014
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Provider Practice Location Address
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Address Line | 519 RIVER RD SECOND FLOOR
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City | EDGEWATER
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State | NJ
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Zip | 07020-1146
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Country | US
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Telephone | 201-885-1857
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Fax | 877-598-9776
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Provider Business Mailing Address
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Address Line | 300 AVALON DR UNIT 3274
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City | WOOD RIDGE
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State | NJ
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Zip | 07075-1012
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Country | US
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Telephone | 201-884-1857
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Fax | 877-598-9776
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. AMY HEATHER FISCH
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Credential | DO
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Telephone | 201-884-1857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 25MB07903200
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License Number State | NJ
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