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General NPI Number Information
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NPI Number | 1295137776
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Entity Type | Organization
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Legal Business Name | PREMIER BEHAVIORAL SERVICES INC
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 81 HALLEY DR
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City | POMONA
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State | NY
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Zip | 10970-2109
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Country | US
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Telephone | 646-286-9770
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Fax |
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Provider Business Mailing Address
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Address Line | 81 HALLEY DR
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City | POMONA
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State | NY
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Zip | 10970-2109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NNAMDI MADUEKWE
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Credential | MD
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Telephone | 646-286-9770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 244833
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License Number State | NY
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