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General NPI Number Information
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NPI Number | 1114879558
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Entity Type | Organization
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Legal Business Name | PREMIUM THERAPEUTICS
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 179 BRECKENRIDGE DR
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-3240
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Country | US
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Telephone | 347-526-1502
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Fax |
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Provider Business Mailing Address
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Address Line | 179 BRECKENRIDGE DR
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-3240
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Country | US
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Telephone | 347-526-1502
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STANFORD JOSEPH
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Credential | PTA
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Telephone | 347-526-1502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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