Provider Demographics
NPI:1639102734
Name:PREMIER HEALTH CHOICE MEDICAL, PC
Entity Type:Organization
Organization Name:PREMIER HEALTH CHOICE MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-245-6800
Mailing Address - Street 1:691 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-2101
Mailing Address - Country:US
Mailing Address - Phone:914-245-6800
Mailing Address - Fax:914-245-6865
Practice Address - Street 1:691 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SHRUB OAK
Practice Address - State:NY
Practice Address - Zip Code:10588-2101
Practice Address - Country:US
Practice Address - Phone:914-245-6800
Practice Address - Fax:914-245-6865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE94693Medicare UPIN
NYWDW981Medicare ID - Type Unspecified