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General NPI Number Information
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NPI Number | 1417524224
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Entity Type | Organization
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Legal Business Name | PREMIER PODIATRY, L.L.C.
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Dates
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Enumeration Date | 06/09/2021
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 502 HAMBURG TPKE STE 105
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City | WAYNE
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State | NJ
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Zip | 07470-8446
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Country | US
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Telephone | 973-384-4444
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Fax | 866-756-0438
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Provider Business Mailing Address
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Address Line | 925 CLIFTON AVE STE 108
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City | CLIFTON
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State | NJ
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Zip | 07013-2724
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Country | US
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Telephone | 973-315-5555
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Fax | 866-756-0438
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | DR. VELIMIR R PETKOV
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Credential | DPM
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Telephone | 917-667-4585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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