Healthcare Provider Details

I. General information

NPI: 1942740097
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CROSSWICKS RD SUITE 11
BORDENTOWN NJ
08505-2602
US

IV. Provider business mailing address

231 CROSSWICKS RD SUITE 11
BORDENTOWN NJ
08505-2602
US

V. Phone/Fax

Practice location:
  • Phone: 609-298-7204
  • Fax:
Mailing address:
  • Phone: 609-298-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SW00969100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SW00969100
License Number StateNJ

VIII. Authorized Official

Name: MRS. MICHELE MIGLIACCIO
Title or Position: MANAGER
Credential:
Phone: 813-539-1543