Provider Demographics
NPI:1417524224
Name:PREMIER PODIATRY, L.L.C.
Entity Type:Organization
Organization Name:PREMIER PODIATRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VELIMIR
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-667-4585
Mailing Address - Street 1:925 CLIFTON AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2724
Mailing Address - Country:US
Mailing Address - Phone:973-315-5555
Mailing Address - Fax:866-756-0438
Practice Address - Street 1:502 HAMBURG TPKE STE 105
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8446
Practice Address - Country:US
Practice Address - Phone:973-315-5555
Practice Address - Fax:866-756-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty