Basic Information
| Provider Information | |||||||||
| NPI: | 1083059877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER PHYSICIANS OF NEW YORK PLLC | ||||||||
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| OtherOrganizationName: | ELLIOT NADELSON, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3599 UNIVERSITY BLVD S | ||||||||
| Address2: | SUITE 805 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043098680 | ||||||||
| FaxNumber: | 9043455841 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 E 12TH ST | ||||||||
| Address2: | SUITE 2-1 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100034513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127272887 | ||||||||
| FaxNumber: | 2129248870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2013 | ||||||||
| LastUpdateDate: | 05/07/2013 | ||||||||
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| AuthorizedOfficialLastName: | TERK | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9044832310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.