Healthcare Provider Details

I. General information

NPI: 1730960717
Provider Name (Legal Business Name): PREMIER NEUROMONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 CLIFTON AVE FL 2
CLIFTON NJ
07013-2711
US

IV. Provider business mailing address

999 CLIFTON AVE FL 2
CLIFTON NJ
07013-2711
US

V. Phone/Fax

Practice location:
  • Phone: 973-354-2484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID DELVECCHIO
Title or Position: COO
Credential:
Phone: 888-302-4007