Organization
PREMIERE NEPHROLOGY AND HYPERTENSION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA LOURDES SILVA-KHAZAEI MD (OWNER)
(908) 353-2064
Entity
Organization
Contact information
Practice address
240 WILLIAMSON ST, SUITE 405, ELIZABETH, NJ 07202-3674
(908) 353-2064
Mailing address
240 WILLIAMSON ST, SUITE 405, ELIZABETH, NJ 07202-3674
(908) 353-2064
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA064906
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8761302
—
NJ
Enumeration date
04/16/2013
Last updated
02/07/2014
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