Healthcare Provider Details

I. General information

NPI: 1134170103
Provider Name (Legal Business Name): PREMIER HEALTH CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PROSPECT AVE UNIT LG
HACKENSACK NJ
07601-2512
US

IV. Provider business mailing address

277 PROSPECT AVE UNIT LG
HACKENSACK NJ
07601-2570
US

V. Phone/Fax

Practice location:
  • Phone: 201-968-0303
  • Fax: 201-968-0330
Mailing address:
  • Phone: 201-968-0303
  • Fax: 201-968-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00576300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01062200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PHILLIP S KIM
Title or Position: PRESIDENT
Credential: D.C.
Phone: 201-968-0303