Provider Demographics
NPI:1891881041
Name:PREMIER HEALTH AND WELLNESSPETER
Entity Type:Organization
Organization Name:PREMIER HEALTH AND WELLNESSPETER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:ALOI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-292-1910
Mailing Address - Street 1:233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3043
Mailing Address - Country:US
Mailing Address - Phone:732-292-1910
Mailing Address - Fax:732-292-1907
Practice Address - Street 1:233 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3043
Practice Address - Country:US
Practice Address - Phone:732-292-1910
Practice Address - Fax:732-292-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ086-282Medicare ID - Type Unspecified