MEDICARE: PREMIUM HEALTH INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1336840594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM HEALTH INC

Provider Business Mailing Address
First Line	:	365 ROUTE 59
Second Line	:
City	:	AIRMONT
State	:	NY
Zip	:	10952-3459
Country	:	US
Telephone Number	:	718-407-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 SEAGIRT BLVD
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4551
Country	:	US
Telephone Number	:	718-407-7300
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING ADMINISTRATOR
Name	:	GALINA HOOLIN
Credential	:
Telephone Number	:	718-407-7300

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	05/15/2024

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Directions to “PREMIUM HEALTH INC ” Practice Location

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