Provider Demographics
NPI:1659715258
Name:PREMIER FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:PREMIER FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIERZBICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-824-7179
Mailing Address - Street 1:5 WALTER E FORAN BLVD STE 4000
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4675
Mailing Address - Country:US
Mailing Address - Phone:908-824-7179
Mailing Address - Fax:908-824-7684
Practice Address - Street 1:5 WALTER E FORAN BLVD STE 4000
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4675
Practice Address - Country:US
Practice Address - Phone:908-824-7179
Practice Address - Fax:908-824-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH73295Medicare UPIN