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General NPI Number Information
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NPI Number | 1568092476
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL LLC
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 400 FOXBOROUGH BLVD APT 4208
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City | FOXBOROUGH
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State | MA
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Zip | 02035-3807
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Country | US
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Telephone | 443-813-3117
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Fax |
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Provider Business Mailing Address
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Address Line | 91 FAIRHAVEN DR
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-1018
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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 | PRESIDENT, CHIEF MEDICAL OFFICER
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Name | DR. ERMAL BOJDANI
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Credential | MD
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Telephone | 443-813-3117
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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 |
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License Number State |
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