Provider Demographics
NPI:1508182072
Name:PREMIER PSYCHIATRIC CONSULTANTS LLC
Entity Type:Organization
Organization Name:PREMIER PSYCHIATRIC CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YISSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-345-4273
Mailing Address - Street 1:6000 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1420
Mailing Address - Country:US
Mailing Address - Phone:201-864-4897
Mailing Address - Fax:201-864-4871
Practice Address - Street 1:6000 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-1420
Practice Address - Country:US
Practice Address - Phone:201-864-4897
Practice Address - Fax:201-864-4871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0821070261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1750585709OtherNPI