NPI Code Details Logo

NPI 1669326575

NPI 1669326575 : PREMIER BRAIN AND SPINE, LLC : WEST DEPTFORD, NJ

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1669326575
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    PREMIER BRAIN AND SPINE, LLC 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    02/26/2026
-----------------------------------------------------
    Last Update Date     |    02/26/2026
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    1225 N BROAD ST STE 3 
-----------------------------------------------------
    City                 |    WEST DEPTFORD
-----------------------------------------------------
    State                |    NJ
-----------------------------------------------------
    Zip                  |    08096-1203
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    856-845-0707
-----------------------------------------------------
    Fax                  |    856-845-0082
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    90 MATAWAN RD STE 302 
-----------------------------------------------------
    City                 |    MATAWAN
-----------------------------------------------------
    State                |    NJ
-----------------------------------------------------
    Zip                  |    07747-2653
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    732-441-7177
-----------------------------------------------------
    Fax                  |    732-441-7165
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    PART-OWNER, MNG MEMBER, MEDICAL DIR
-----------------------------------------------------
    Name                 |    DR. ERIC D FREEMAN 
-----------------------------------------------------
    Credential           |    MD
-----------------------------------------------------
    Telephone            |    732-906-9600
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    207XS0117X
-----------------------------------------------------
    Taxonomy Name        |    Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    332B00000X
-----------------------------------------------------
    Taxonomy Name        |    Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.