Organization
PREMIER SPINE AND SPORTS MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUBY E KIM M.D. (PHYSICIAN)
(201) 242-1600
Entity
Organization
Contact information
Practice address
1555 CENTER AVE, FORT LEE, NJ 07024-4612
(201) 242-1600
Mailing address
1555 CENTER AVE, 2ND FLOOR, FORT LEE, NJ 07024-4612
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
25MA08795900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150155GF6
MEDICARE
NJ
Enumeration date
02/13/2013
Last updated
09/27/2013
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