Provider Demographics
NPI:1871024323
Name:PREMIER ANESTHESIA AND PAIN PHYSICIANS
Entity Type:Organization
Organization Name:PREMIER ANESTHESIA AND PAIN PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSRAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-255-6391
Mailing Address - Street 1:4 HICKORY LANE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2602
Mailing Address - Country:US
Mailing Address - Phone:718-255-6391
Mailing Address - Fax:
Practice Address - Street 1:3729 EASTON NAZARETH HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8344
Practice Address - Country:US
Practice Address - Phone:718-255-6391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418555207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty