=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154451987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER PROFESSIONAL TEMPS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2011 LEMOINE AVE SUITE 205
-----------------------------------------------------
City | FORT LEE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07024-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-461-9595
-----------------------------------------------------
Fax | 201-461-9662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2011 LEMOINE AVE SUITE 205
-----------------------------------------------------
City | FORT LEE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07024-5700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-461-9595
-----------------------------------------------------
Fax | 201-461-9662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. EDYTHE RESSLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-461-9595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HP0089300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------