Provider Demographics
NPI:1700914959
Name:PREMIER INTERNAL MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:PREMIER INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANWARDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:AIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-948-3474
Mailing Address - Street 1:444 HUGUENOT AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1119
Mailing Address - Country:US
Mailing Address - Phone:718-948-3474
Mailing Address - Fax:718-948-3446
Practice Address - Street 1:444 HUGUENOT AVENUE
Practice Address - Street 2:STE A
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1119
Practice Address - Country:US
Practice Address - Phone:718-948-3474
Practice Address - Fax:718-948-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207334207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWS401Medicare PIN