| Premier Medical, Pllc | |
|
265 Mason Ave Staten Island NY 10305-3412 | |
| (718) 979-5880 | |
| (718) 979-6476 |
| Full Name | Premier Medical, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 265 Mason Ave, Staten Island, New York |
| Authorized Official Name and Position | Jeffry Tambor (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7189795880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Medical, Pllc Po Box 141296 Staten Island NY 10314-1296 Ph: (718) 979-5880 | Premier Medical, Pllc 265 Mason Ave Staten Island NY 10305-3412 Ph: (718) 979-5880 |
| NPI Number | 1962682864 |
|---|---|
| Provider Enumeration Date | 11/07/2007 |
| Last Update Date | 11/02/2015 |
| Medicare PECOS PAC ID | 4082504691 |
|---|---|
| Medicare Enrollment ID | O20110208000716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962682864 | NPI | - | NPPES |
| 01925915 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 158418 (New York) | Primary |
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