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Organization

FIVE STAR PREMIER MEDICAL CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ERNESTO BERDU (CREDENTIALING)
(201) 758-1101
Entity
Organization

Contact information

Practice address
470 CHAMBERLAIN AVE, SUITE#7, PATERSON, NJ 07522-1031
(973) 595-7400
(973) 345-4156
Mailing address
PO BOX 3247, WAYNE, NJ 07474-3247

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
25MA07147400
NJ
207Q00000X
Family Medicine Physician
Primary
25MA07147400
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8376808
NJ
Enumeration date
09/13/2011
Last updated
09/13/2011
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