Healthcare Provider Details

I. General information

NPI: 1811643000
Provider Name (Legal Business Name): PREMIER NEUROPHYSIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EISENHOWER PKWY STE 300
ROSELAND NJ
07068-1054
US

IV. Provider business mailing address

101 EISENHOWER PKWY STE 300
ROSELAND NJ
07068-1054
US

V. Phone/Fax

Practice location:
  • Phone: 908-590-1917
  • 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: WIDNY PIERRE
Title or Position: NEUROPHYSIOLOGY/TECH
Credential:
Phone: 908-590-1917