Provider Demographics
NPI:1457080178
Name:PLATINUM PROVIDERS GROUP LLC
Entity Type:Organization
Organization Name:PLATINUM PROVIDERS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ATHANASIOS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAPASTAMELOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-469-1585
Mailing Address - Street 1:2106 NEW RD STE F2
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1053
Mailing Address - Country:US
Mailing Address - Phone:609-798-0111
Mailing Address - Fax:609-681-5730
Practice Address - Street 1:2301 E EVESHAM RD STE 306
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4503
Practice Address - Country:US
Practice Address - Phone:856-554-3822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty