Healthcare Provider Details

I. General information

NPI: 1043257991
Provider Name (Legal Business Name): PREMIER HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 NEWTON SPARTA RD
NEWTON NJ
07860-2769
US

IV. Provider business mailing address

532 LAFAYETTE RD STE 300
SPARTA NJ
07871-4411
US

V. Phone/Fax

Practice location:
  • Phone: 973-579-6300
  • Fax: 973-579-1524
Mailing address:
  • Phone: 973-940-0423
  • Fax: 973-940-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MYCK
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 973-940-0423