Provider Demographics
NPI:1164679460
Name:PREMIER NEUROMED SERVICES PC
Entity Type:Organization
Organization Name:PREMIER NEUROMED SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:STILOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-578-3060
Mailing Address - Street 1:1147 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2423
Mailing Address - Country:US
Mailing Address - Phone:347-587-3060
Mailing Address - Fax:347-587-3062
Practice Address - Street 1:1147 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2423
Practice Address - Country:US
Practice Address - Phone:347-587-3060
Practice Address - Fax:347-587-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2009-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1660402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A100000368Medicare PIN