Healthcare Provider Details

I. General information

NPI: 1073717294
Provider Name (Legal Business Name): PREMIER CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E MAIN ST
MANASQUAN NJ
08736-3043
US

IV. Provider business mailing address

233 E MAIN ST
MANASQUAN NJ
08736-3043
US

V. Phone/Fax

Practice location:
  • Phone: 732-528-5533
  • Fax: 732-528-0360
Mailing address:
  • Phone: 732-528-5533
  • Fax: 732-528-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARTIN E. MANZO
Title or Position: OWNER CLINIC DIRECTOR
Credential: DC
Phone: 732-528-5533