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General NPI Number Information
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NPI Number | 1811643000
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Entity Type | Organization
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Legal Business Name | PREMIER NEUROPHYSIOLOGY
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 101 EISENHOWER PKWY STE 300
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City | ROSELAND
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State | NJ
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Zip | 07068-1054
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Country | US
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Telephone | 908-590-1917
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Fax |
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Provider Business Mailing Address
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Address Line | 101 EISENHOWER PKWY STE 300
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City | ROSELAND
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State | NJ
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Zip | 07068-1054
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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 | NEUROPHYSIOLOGY/TECH
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Name | WIDNY PIERRE
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Credential |
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Telephone | 908-590-1917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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