MEDICARE: PREMIUM THERAPEUTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist

General Provider Information

NPI Number	:	1114879558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM THERAPEUTICS

Provider Business Mailing Address
First Line	:	179 BRECKENRIDGE DR
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-3240
Country	:	US
Telephone Number	:	347-526-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 BRECKENRIDGE DR
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-3240
Country	:	US
Telephone Number	:	347-526-1502
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STANFORD JOSEPH
Credential	:	PTA
Telephone Number	:	347-526-1502

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

Similar Medicare Providers

1780053264 — JENNIFER VEERASAMY
Practice Location Address:

179 BRECKENRIDGE DR
SICKLERVILLE, NJ
08081-3240

Practice Phone: 917-279-8350
Practice Fax:

1609236603 — ESTHER ADELEKE
Practice Location Address:

171 BRECKENRIDGE DR
SICKLERVILLE, NJ
08081-3240

Practice Phone: 952-681-1400
Practice Fax:

1649025602 — EATING DISORDER & ANXIETY CENTER OF NEW JERSEY
Practice Location Address:

187 BRECKENRIDGE DR
SICKLERVILLE, NJ
08081-3240

Practice Phone: 215-206-1749
Practice Fax:

1245181841 — DR. KILEY ANN FULTON OTD, OTR/L
Practice Location Address:

20 DUKE DR
SICKLERVILLE, NJ
08081-4708

Practice Phone: 609-634-7134
Practice Fax:

1063427052 — WALGREEN CO
Practice Location Address:

590 CROSS KEYS RD
SICKLERVILLE, NJ
08081

Practice Phone: 856-629-6507
Practice Fax: 856-629-7145

1285636761 — DR. VIVEK NAVANEETHAN M.S., PHARM. D.
Practice Location Address:

8 BRIDLE PATH CT
SICKLERVILLE, NJ
08081-5645

Practice Phone: 856-629-7807
Practice Fax: 856-629-7807

Directions to “PREMIUM THERAPEUTICS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.