1174672240 NPI number — PREMIER MEDICAL ASSOCIATE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174672240 NPI number — PREMIER MEDICAL ASSOCIATE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER MEDICAL ASSOCIATE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174672240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1873 PATTERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10473-3039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-589-2799
Provider Business Mailing Address Fax Number:
718-328-6839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1873 PATTERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10473-3039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-589-2799
Provider Business Practice Location Address Fax Number:
718-328-6839
Provider Enumeration Date:
01/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
HITESH
Authorized Official Middle Name:
BABUBHAI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-589-2799

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  236025 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)