1770950214 NPI number — PRINCETON HEALTHCARE PROVIDER GROUP LLC

Table of content: (NPI 1770950214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770950214 NPI number — PRINCETON HEALTHCARE PROVIDER GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCETON HEALTHCARE PROVIDER GROUP 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:
PRINCETON MEDICINE HEART GROUP
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:
1770950214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 PRINCESS RD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08648-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-243-0445
Provider Business Mailing Address Fax Number:
609-844-1092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PLAINSBORO RD
Provider Second Line Business Practice Location Address:
SANDS CENTER FOR CARDIAC AND PULMONARY CARE
Provider Business Practice Location Address City Name:
PLAINSBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08536-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-853-7885
Provider Business Practice Location Address Fax Number:
609-853-7886
Provider Enumeration Date:
09/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BERGMANN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
609-853-7220

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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