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General NPI Number Information
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NPI Number | 1154764595
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Entity Type | Organization
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Legal Business Name | PREMIERE NEPHROLOGY AND HYPERTENSION LLC
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 240 WILLIAMSON ST SUITE 405
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City | ELIZABETH
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State | NJ
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Zip | 07202-3674
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Country | US
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Telephone | 908-353-2064
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Fax |
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Provider Business Mailing Address
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Address Line | 240 WILLIAMSON ST SUITE 405
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City | ELIZABETH
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State | NJ
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Zip | 07202-3674
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Country | US
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Telephone | 908-353-2064
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIA LOURDES SILVA-KHAZAEI
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Credential | MD
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Telephone | 908-353-2064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA064906
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License Number State | NJ
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