Premier Medical Alliance LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

25MA05477400 Issued in NJ

Legal business name

PREMIER MEDICAL ALLIANCE LLC

Practice address

466 Old Hook Road
Suite 1
Emerson, NJ 07630-1368

Phone

(201) 967-8221

Fax

(201) 634-9647

NPI assigned

Oct 11, 2013

Last updated

Oct 11, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eric Avezzano, MDNPI 1578591814

Title

President

Phone

(201) 967-8221

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eric S Avezzano, MD

  • Gastroenterology Physician
  • Emerson, NJ
  • NPI 1578591814
  Medicare reassignment NPD Authorized official
• Pamela Sue Lavrich, M.D.

  • Anesthesiology Physician
  • Wyckoff, NJ
  • NPI 1255492310
  Medicare reassignment Care Compare group NPD
• Vasiliki Leonidas Saitas, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Emerson, NJ
  • NPI 1427105428
  Medicare reassignment Care Compare group NPD
• Carlos Frias, M.D.

  • Anesthesiology Physician
  • Passaic, NJ
  • NPI 1235132440
  Medicare reassignment Care Compare group
• Michael A Reuveni, M.D.

  • Anesthesiology Physician
  • Passaic, NJ
  • NPI 1649273707
  Medicare reassignment Care Compare group
• Varalakshmi Annadanam, M.D

  • Anesthesiology Physician
  • Totowa, NJ
  • NPI 1528061751
  Medicare reassignment NPD
• Alyse R Bellomo, MD

  • Gastroenterology Physician
  • Emerson, NJ
  • NPI 1700890837
  Medicare reassignment NPD
• Bhavik Mukesh Bhandari, M.D.

  • Gastroenterology Physician
  • Emerson, NJ
  • NPI 1679763890
  Medicare reassignment NPD
• Marina Boukiia, M.D.

  • Anesthesiology Physician
  • Totowa, NJ
  • NPI 1588667711
  Medicare reassignment NPD
• Alan J Briker, MD

  • Internal Medicine Physician
  • Emerson, NJ
  • NPI 1942238654
  Medicare reassignment NPD
• Crystal N Broussard, MD

  • Gastroenterology Physician
  • Emerson, NJ
  • NPI 1114955846
  Medicare reassignment NPD
• Alicia D. Carti, APN-C

  • Nurse Practitioner
  • Clifton, NJ
  • NPI 1356339956
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381449600000",
    "number": "1093142895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK ROAD",
            "address_2": "SUITE 1",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301368",
            "telephone_number": "201-967-8221",
            "fax_number": "201-634-9647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "466 OLD HOOK ROAD",
            "address_2": "SUITE 1",
            "city": "EMERSON",
            "state": "NJ",
            "postal_code": "076301368",
            "telephone_number": "201-967-8221",
            "fax_number": "201-634-9647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL ALLIANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-11",
        "last_updated": "2013-10-11",
        "status": "A",
        "authorized_official_last_name": "AVEZZANO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-967-8221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NJ",
            "license": "25MA0806440",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NJ",
            "license": "25MA05477400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sruti Patel, M.D.
• Ellen Petak Jacowitz I, LCSW
• Lia Petrocelli, PHARMD
• Dayna Phillips, M.D.
• Robert H Pittman, MD
• Brittany Anne Prisco, MS CCC-SLP
• Proactive Foot and Ankle
• Professional Occupational & Physical Therapy, PLLC
• Professional Orthopedic and Sports Physical Therapy of NJ, LLC
• Professional Sports Medicine Associates

• Gastroenterology Physician in Emerson, NJ
• Providers in Emerson, NJ by specialty
• Gastroenterology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.