Healthcare Provider Details

I. General information

NPI: 1295082527
Provider Name (Legal Business Name): PREMIER PHYSICIANS OF NEW YORK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 BROADWAY
NEW YORK NY
10013-3699
US

IV. Provider business mailing address

2865 E COAST HWY SUITE 200
CORONA DEL MAR CA
92625-2236
US

V. Phone/Fax

Practice location:
  • Phone: 212-925-8882
  • Fax: 904-345-5841
Mailing address:
  • Phone: 949-207-3111
  • Fax: 949-612-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO LIPSZTEIN
Title or Position: DIRECTOR
Credential: MD
Phone: 212-925-8882