Provider Demographics
NPI:1053593616
Name:HIGH STREET REHAB, LLC
Entity type:Organization
Organization Name:HIGH STREET REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-235-1515
Mailing Address - Street 1:25 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1131
Mailing Address - Country:US
Mailing Address - Phone:973-235-1515
Mailing Address - Fax:973-235-0452
Practice Address - Street 1:25 HIGH ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1131
Practice Address - Country:US
Practice Address - Phone:973-235-1515
Practice Address - Fax:973-235-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC02501111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ027156Medicare PIN