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General NPI Number Information
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NPI Number | 1992210512
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Entity Type | Organization
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Legal Business Name | PREMIER ANESTHESIA ASSOCIATES PA
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 55 MEADOWLANDS PKWY
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City | SECAUCUS
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State | NJ
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Zip | 07094-2977
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Country | US
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Telephone | 201-392-3228
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Fax | 201-392-3526
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Provider Business Mailing Address
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Address Line | 457 LEWELEN CIR
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2024
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Country | US
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Telephone | 718-222-5999
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Fax | 718-387-6429
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Authorized Official
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Title or Position | CEO
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Name | LEONID SHAPIRO
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Credential | MD
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Telephone | 201-803-0191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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