Provider Demographics
NPI:1205264488
Name:PREMIER HEALTH GROUP LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:PREMIER HEALTH GROUP LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AXEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PFLUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:732-982-4464
Mailing Address - Street 1:2275 W COUNTY LINE RD STE 6-212
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2354
Mailing Address - Country:US
Mailing Address - Phone:732-982-4464
Mailing Address - Fax:732-994-0146
Practice Address - Street 1:3297 ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2762
Practice Address - Country:US
Practice Address - Phone:732-982-4464
Practice Address - Fax:732-994-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment