Organization
PREMIER MEDICAL ALLIANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIC AVEZZANO MD (PRESIDENT)
(201) 967-8221
Entity
Organization
Contact information
Practice address
466 OLD HOOK ROAD, SUITE 1, EMERSON, NJ 07630-1368
(201) 967-8221
(201) 634-9647
Mailing address
466 OLD HOOK ROAD, SUITE 1, EMERSON, NJ 07630-1368
(201) 967-8221
(201) 634-9647
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
25MA0806440
NJ
207RG0100X
Gastroenterology Physician
Primary
25MA05477400
NJ
Other
Enumeration date
10/11/2013
Last updated
10/11/2013
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