Five Star Premier Medical Care Llc
Family Medicine Physician in Paterson, NJ(View on Map)
Legal Business Name
Five Star Premier Medical Care Llc
NPI Number
1821370149
NPI Type
Organization
Enumeration Date
09/13/2011
Specialties
(Taxonomies)Code
207Q00000X
207P00000X
Primary Taxonomy
Yes
No
Licenses
State
New Jersey
License Number
25MA07147400
Contact
Information
Purpose
Mailing
Location
Address
PO BOX 3247
470 CHAMBERLAIN AVE
City
Wayne
Paterson
State
NJ
NJ
Postal Code
07474-3247
07522-1031
Country
US
US
Telephone Number
N/A
(973) 595-7400
Authorized Official
Name
Ernesto Berdu
Title or Position
CREDENTIALING
Telephone Number
(201) 758-1101
Identifiers
Identifier
8376808
Identifier State
NJ
Identifier Issuer
Unknown
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 09/13/2011
Provider Address
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