=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063215762
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER BRAIN AND SPINE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2025
-----------------------------------------------------
Last Update Date | 04/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 MOUNT PLEASANT AVE STE A
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07801-1630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-989-0888
-----------------------------------------------------
Fax | 973-989-0885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 MATAWAN RD STE 302
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-2653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-441-7177
-----------------------------------------------------
Fax | 732-441-7165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PART-OWNER; MANAGING MEMBER
-----------------------------------------------------
Name | DR. ERIC D FREEMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 732-906-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------