NPIMap

Organization Active NPI

Premier Healthcare, Inc.

  • Developmental Disabilities Clinic/Center
  • New York, NY
National Provider Identifier
1831330182
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
PREMIER HEALTHCARE, INC.
Practice address
460 West 34TH Street
9TH Floor
New York, NY 10001-2382
Phone
(212) 273-6519
NPI assigned
Mar 17, 2009
Organization subpart
Yes
Parent organization
PREMIER HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

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

Authorized official

Name
Mr. Vlad Kuznetsov, PHD, MBA, PA
Title
Executive Director
Phone
(212) 273-6116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X NY Primary

Addresses

Primary practice location

460 West 34TH Street
9TH Floor
New York, NY 10001-2382

Mailing address

460 W 34TH St FL 11
New York, NY 10001-2382
Phone (212) 273-6100

Other names 1

  • Premier Healthcare Article 16 Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040122000144 NY Part B Supplier - Clinic/Group Practice 1254233158 Receives reassigned benefits from 164 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY; New York, NY; Brooklyn, NY; Bayside, NY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Premier Healthcare4 organizations share this tax ID, including this one
Part of
Premier Healthcare

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

175 Remsen St
Fl 4
Brooklyn, NY 11201
Phone (212) 273-6182

Practitioners & affiliated clinicians

Practitioners 189

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 189

NPI Registry JSON

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

{
    "created_epoch": "1237248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1831330182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 W 34TH ST FL 11",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100012382",
            "telephone_number": "212-273-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 WEST 34TH STREET",
            "address_2": "9TH FLOOR",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100012382",
            "telephone_number": "212-273-6519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIER HEALTHCARE, INC.",
        "enumeration_date": "2009-03-17",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "KUZNETSOV",
        "authorized_official_first_name": "VLAD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "212-273-6116",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD, MBA, PA"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Healthcare Article 16",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.