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General NPI Number Information
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NPI Number | 1962874610
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Entity Type | Organization
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Legal Business Name | PREMIER IMAGING CORPORATION
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 900 W MAIN ST SUITE 3
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City | FREEHOLD
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State | NJ
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Zip | 07728-2523
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Country | US
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Telephone | 732-308-2255
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Fax | 732-308-0081
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Provider Business Mailing Address
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Address Line | 900 W MAIN ST SUITE 3
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City | FREEHOLD
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State | NJ
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Zip | 07728-2523
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Country | US
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Telephone | 732-308-2255
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Fax | 732-308-0081
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CASANDRA AUTRY
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Credential | M.D.
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Telephone | 732-308-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 25MA06928800
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License Number State | NJ
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