Provider Demographics
NPI:1417142613
Name:PREMIER MEDICAL ONCOLOGY, LLC
Entity Type:Organization
Organization Name:PREMIER MEDICAL ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-243-1003
Mailing Address - Street 1:631 BROADWAY
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3846
Mailing Address - Country:US
Mailing Address - Phone:201-243-1003
Mailing Address - Fax:201-243-1006
Practice Address - Street 1:631 BROADWAY
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3846
Practice Address - Country:US
Practice Address - Phone:201-243-1003
Practice Address - Fax:201-243-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06130100207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty