Healthcare Provider Details

I. General information

NPI: 1568092476
Provider Name (Legal Business Name): PREMIER MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FOXBOROUGH BLVD APT 4208
FOXBOROUGH MA
02035-3807
US

IV. Provider business mailing address

91 FAIRHAVEN DR
MIDLAND PARK NJ
07432-1018
US

V. Phone/Fax

Practice location:
  • Phone: 443-813-3117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERMAL BOJDANI
Title or Position: PRESIDENT, CHIEF MEDICAL OFFICER
Credential: MD
Phone: 443-813-3117