Healthcare Provider Details

I. General information

NPI: 1275857427
Provider Name (Legal Business Name): PREMIER MEDICAL AND SPORTS REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 MAIN ST
PRINCETON NJ
08540-5755
US

IV. Provider business mailing address

PO BOX 510
CHATHAM NJ
07928-0510
US

V. Phone/Fax

Practice location:
  • Phone: 973-713-9712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC004002800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number47709
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD002672
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4DQA00915800
License Number StateNJ

VIII. Authorized Official

Name: RICK A DEBIASI
Title or Position: PRESIDENT
Credential: DC
Phone: 973-713-9712