Provider Demographics
NPI:1154764595
Name:PREMIERE NEPHROLOGY AND HYPERTENSION LLC
Entity type:Organization
Organization Name:PREMIERE NEPHROLOGY AND HYPERTENSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:SILVA-KHAZAEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-353-2064
Mailing Address - Street 1:240 WILLIAMSON ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3674
Mailing Address - Country:US
Mailing Address - Phone:908-353-2064
Mailing Address - Fax:
Practice Address - Street 1:240 WILLIAMSON ST
Practice Address - Street 2:SUITE 405
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3674
Practice Address - Country:US
Practice Address - Phone:908-353-2064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA064906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8761302Medicaid
NJ8761302Medicaid