Provider Demographics
NPI:1144540840
Name:HIGHLAND MEDICAL GROUP, PC
Entity type:Organization
Organization Name:HIGHLAND MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDR
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAITSEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-574-2070
Mailing Address - Street 1:P.O. BOX 1115
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:973-574-2070
Mailing Address - Fax:973-574-2090
Practice Address - Street 1:165 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:973-574-2070
Practice Address - Fax:973-574-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07388400174400000X, 208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty