1518216092 NPI number — PREMIER SPINE & PAIN MANAGEMENT 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 1518216092 NPI number — PREMIER SPINE & PAIN MANAGEMENT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER SPINE & PAIN MANAGEMENT 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:
1518216092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 OMNI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBOROUGH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08844-4528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-438-5071
Provider Business Mailing Address Fax Number:
610-438-5073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 OMNI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08844-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-438-5071
Provider Business Practice Location Address Fax Number:
610-438-5073
Provider Enumeration Date:
08/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KANDRA
Authorized Official First Name:
ARUN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
610-438-5071

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  MD439157 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com