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General NPI Number Information
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NPI Number | 1831330182
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTHCARE, INC.
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 460 WEST 34TH STREET 9TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-2382
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Country | US
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Telephone | 212-273-6519
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Fax |
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Provider Business Mailing Address
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Address Line | 460 W 34TH ST FL 11
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City | NEW YORK
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State | NY
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Zip | 10001-2382
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Country | US
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Telephone | 212-273-6100
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. VLAD KUZNETSOV
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Credential | PHD, MBA, PA
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Telephone | 212-273-6116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State | NY
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