Healthcare Provider Details

I. General information

NPI: 1568756856
Provider Name (Legal Business Name): PREMIUM ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

8 BRAINTREE CT
FLEMINGTON NJ
08822-4624
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARILENA TOLEA
Title or Position: PRESIDENT
Credential: MD
Phone: 908-237-0403