Healthcare Provider Details

I. General information

NPI: 1023379054
Provider Name (Legal Business Name): PREMIER PHYSIATRY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 W WILDWOOD RD
SADDLE RIVER NJ
07458-2512
US

IV. Provider business mailing address

48 W WILDWOOD RD
SADDLE RIVER NJ
07458-2512
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-1003
  • Fax: 973-839-3653
Mailing address:
  • Phone: 973-839-1003
  • Fax: 973-839-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS SCOTT HOLDEN
Title or Position: OWNER
Credential: MD
Phone: 973-839-1003