Provider Demographics
NPI:1447507827
Name:PREMIER PHYSICIANS OF NEW YORK PLLC
Entity type:Organization
Organization Name:PREMIER PHYSICIANS OF NEW YORK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSZTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-309-8680
Mailing Address - Street 1:2865 E COAST HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2236
Mailing Address - Country:US
Mailing Address - Phone:949-207-3111
Mailing Address - Fax:949-612-8255
Practice Address - Street 1:61 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1817
Practice Address - Country:US
Practice Address - Phone:212-772-2130
Practice Address - Fax:904-345-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0354168Medicaid
NYA100078414Medicare PIN