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General NPI Number Information
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NPI Number | 1962682864
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Entity Type | Organization
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Legal Business Name | PREMIER MEDICAL, PLLC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 265 MASON AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3412
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Country | US
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Telephone | 718-979-5880
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Fax | 718-979-6476
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Provider Business Mailing Address
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Address Line | PO BOX 141296
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1296
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Country | US
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Telephone | 718-979-5880
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Fax | 718-979-6476
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEFFRY TAMBOR
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Credential | M.D.
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Telephone | 718-979-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 158418
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License Number State | NY
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