1215288089 NPI number — PRINCETON INTEGRAL ENDOCRINOLOGY, LLC

Table of content: (NPI 1215288089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215288089 NPI number — PRINCETON INTEGRAL ENDOCRINOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCETON INTEGRAL ENDOCRINOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARIA I BENITO-HERRERO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215288089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 MAPLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08542-3850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-252-0201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 NASSAU ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08542-4509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-649-3161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BENITO-HERRERO
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
INMACULADA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
609-649-3161

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  25MA08101000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com