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1720968464 NPI number — PREMIER BRAIN AND SPINE LLC

NPI Number: 1720968464
Health Care Provider/Practitioner: PREMIER BRAIN AND SPINE LLC

Information about “1720968464” NPI (PREMIER BRAIN AND SPINE LLC) exists in 1720968464 in HTML format HTML  |  1720968464 in plain Text format TXT  |  1720968464 in PDF (Portable Document Format) PDF  |  1720968464 in an XML format XML  formats.

NPI Number : 1720968464 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720968464",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PREMIER BRAIN AND SPINE LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "90 MATAWAN RD STE 302",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MATAWAN",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07747-2653",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "732-441-7177",
    "MailingAddressFaxNumber": "732-441-7165",
    "FirstLinePracticeLocationAddress": "1215 ROUTE 70 STE 1001",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKEWOOD",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08701-6958",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "732-584-2400",
    "PracticeLocationAddressFaxNumber": "848-305-6003",
    "EnumerationDate": "09/04/2025",
    "LastUpdateDate": "09/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FREEMAN",
    "AuthorizedOfficialFirstName": "ERIC",
    "AuthorizedOfficialMiddleName": "D",
    "AuthorizedOfficialTitle": "PART-OWNER; MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "732-906-9600",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208VP0000X",
          "TaxonomyName": "Pain Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "332B00000X",
          "TaxonomyName": "Durable Medical Equipment & Medical Supplies",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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