Provider Demographics
NPI:1154953800
Name:PREMIUMCBT
Entity type:Organization
Organization Name:PREMIUMCBT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-682-4300
Mailing Address - Street 1:35 W HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1718
Mailing Address - Country:US
Mailing Address - Phone:201-408-4487
Mailing Address - Fax:800-352-3015
Practice Address - Street 1:35 W HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1718
Practice Address - Country:US
Practice Address - Phone:201-408-4487
Practice Address - Fax:800-352-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty