MEDICARE: PREMIER PERINATAL, L.L.C.

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	207VM0101X	Maternal & Fetal Medicine Physician	25MA06226600	NJ

General Provider Information

NPI Number	:	1942489174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PERINATAL, L.L.C.

Provider Business Mailing Address
First Line	:	1416 HOOPER AVE
Second Line	:	SUITE 1
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2825
Country	:	US
Telephone Number	:	732-736-0300
Fax Number	:	732-736-9600

Provider Business Practice Location Address
First Line	:	1416 HOOPER AVE
Second Line	:	SUITE 1
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2825
Country	:	US
Telephone Number	:	732-736-0300
Fax Number	:	732-736-9600

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLOS OCTAVIO FERNANDEZ
Credential	:	M.D.
Telephone Number	:	732-736-0300

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2007

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