Provider Demographics
NPI:1386021913
Name:NJ PREMIER MEDICAL CARE
Entity Type:Organization
Organization Name:NJ PREMIER MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGHSOUDLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-2039
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-0717
Mailing Address - Country:US
Mailing Address - Phone:973-773-2039
Mailing Address - Fax:
Practice Address - Street 1:716 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1645
Practice Address - Country:US
Practice Address - Phone:973-773-2039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty