Five Star Premier Medical Care LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MA07147400 Issued in NJ

Legal business name

FIVE STAR PREMIER MEDICAL CARE LLC

Practice address

470 Chamberlain Ave
Suite#7
Paterson, NJ 07522-1031

Phone

(973) 595-7400

Fax

(973) 345-4156

NPI assigned

Sep 13, 2011

Organization subpart

No

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

Authorized official

Name

Ernesto Berdu

Title

Credentialing

Phone

(201) 758-1101

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315872000000",
    "number": "1821370149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3247",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074743247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 CHAMBERLAIN AVE",
            "address_2": "SUITE#7",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075221031",
            "telephone_number": "973-595-7400",
            "fax_number": "973-345-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR PREMIER MEDICAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A",
        "authorized_official_last_name": "BERDU",
        "authorized_official_first_name": "ERNESTO",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "201-758-1101"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MA07147400",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MA07147400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8376808",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Paterson, NJ
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• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.