Provider Demographics
NPI:1679222178
Name:PLATINUM THERAPY
Entity Type:Organization
Organization Name:PLATINUM THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-451-3398
Mailing Address - Street 1:2485 HOLLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-6119
Mailing Address - Country:US
Mailing Address - Phone:732-451-3398
Mailing Address - Fax:
Practice Address - Street 1:2485 HOLLY HILL RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-6119
Practice Address - Country:US
Practice Address - Phone:732-451-3398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center