Provider Demographics
NPI:1023379054
Name:PREMIER PHYSIATRY GROUP LLC
Entity Type:Organization
Organization Name:PREMIER PHYSIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-839-1003
Mailing Address - Street 1:48 W WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2512
Mailing Address - Country:US
Mailing Address - Phone:973-839-1003
Mailing Address - Fax:973-839-3653
Practice Address - Street 1:48 W WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-2512
Practice Address - Country:US
Practice Address - Phone:973-839-1003
Practice Address - Fax:973-839-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty