Provider Demographics
NPI:1093995193
Name:PREMIER SURGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:PREMIER SURGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-886-5545
Mailing Address - Street 1:68 BOULDER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3150
Mailing Address - Country:US
Mailing Address - Phone:877-877-8232
Mailing Address - Fax:
Practice Address - Street 1:68 BOULDER RIDGE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3150
Practice Address - Country:US
Practice Address - Phone:877-877-8232
Practice Address - Fax:877-877-8232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER SURGICAL SERVICES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-06
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198606363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty