Healthcare Provider Details

I. General information

NPI: 1386529717
Provider Name (Legal Business Name): PREMIER BRAIN AND SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS TOWN CIR STE 100
EWING NJ
08638-1962
US

IV. Provider business mailing address

90 MATAWAN RD STE 302
MATAWAN NJ
07747-2653
US

V. Phone/Fax

Practice location:
  • Phone: 609-799-7009
  • Fax: 609-799-7808
Mailing address:
  • Phone: 732-441-7177
  • Fax: 732-441-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC D FREEMAN
Title or Position: PART-OWNER: MANAGING MEMBER
Credential: DO
Phone: 732-906-9600