Provider Demographics
NPI:1407188923
Name:PREMIUM FAMILY HEALTH CARE, LLC
Entity Type:Organization
Organization Name:PREMIUM FAMILY HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SKIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-547-3555
Mailing Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5526
Mailing Address - Country:US
Mailing Address - Phone:201-547-3555
Mailing Address - Fax:201-547-8259
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5526
Practice Address - Country:US
Practice Address - Phone:201-547-3555
Practice Address - Fax:201-547-8259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA071041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH28110Medicare UPIN