MEDICARE: PREMIER BRAIN AND SPINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1407707896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER BRAIN AND SPINE LLC

Provider Business Mailing Address
First Line	:	90 MATAWAN RD STE 302
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-2653
Country	:	US
Telephone Number	:	732-441-7177
Fax Number	:	732-441-7165

Provider Business Practice Location Address
First Line	:	7505 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5459
Country	:	US
Telephone Number	:	551-340-8400
Fax Number	:	551-340-8400

Authorized Official
Title or Position	:	PART-OWNER: MANAGING MEMBER
Name	:	ERIC D FREEMAN
Credential	:	DO
Telephone Number	:	732-906-9600

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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