Provider Demographics
NPI:1205235595
Name:PREMIER PT LIMITED LIABILITY COMP
Entity type:Organization
Organization Name:PREMIER PT LIMITED LIABILITY COMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-467-4444
Mailing Address - Street 1:788 MORRIS TPKE STE 301
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2634
Mailing Address - Country:US
Mailing Address - Phone:973-467-4444
Mailing Address - Fax:973-467-4446
Practice Address - Street 1:788 MORRIS TPKE STE 301
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2634
Practice Address - Country:US
Practice Address - Phone:973-467-4444
Practice Address - Fax:973-467-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00915800261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy