| Premier Family Medical, Pc | |
|
110 Bloomfield Ave Caldwell NJ 07006-5336 | |
| (973) 403-3200 | |
| (973) 403-3250 |
| Full Name | Premier Family Medical, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 110 Bloomfield Ave, Caldwell, New Jersey |
| Authorized Official Name and Position | Vito Mazzoccoli (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9734033200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Family Medical, Pc 110 Bloomfield Ave Caldwell NJ 07006-5336 Ph: (973) 403-3200 | Premier Family Medical, Pc 110 Bloomfield Ave Caldwell NJ 07006-5336 Ph: (973) 403-3200 |
| NPI Number | 1891740643 |
|---|---|
| Provider Enumeration Date | 05/23/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2567454200 |
|---|---|
| Medicare Enrollment ID | O20040401000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891740643 | NPI | - | NPPES |
| 0029483 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MA072343 (New Jersey) | Primary |
| Provider Name | Vito Mazzoccoli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518936053 PECOS PAC ID: 1759373426 Enrollment ID: I20040401000985 |
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