Basic Information
| Provider Information | |||||||||
| NPI: | 1316384753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER PHYSICIANS OF NEW YORK PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2865 E COAST HWY | ||||||||
| Address2: | SUITE 20005 | ||||||||
| City: | CORONA DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926252236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492073111 | ||||||||
| FaxNumber: | 9496128255 | ||||||||
| Practice Location | |||||||||
| Address1: | 10614 70TH AVE | ||||||||
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| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185206620 | ||||||||
| FaxNumber: | 7185206630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2013 | ||||||||
| LastUpdateDate: | 06/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | LIPSZTEIN | ||||||||
| AuthorizedOfficialFirstName: | ROBERTO | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7185206620 | ||||||||
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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 | 2085R0001X | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.