1154353902 NPI number — PRINCETON INTERVENTIONAL CARDIOLOGY PA

Table of content: (NPI 1154353902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154353902 NPI number — PRINCETON INTERVENTIONAL CARDIOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCETON INTERVENTIONAL CARDIOLOGY PA
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:
Provider Other Organization Name Type Code:
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:
1154353902
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 BUNN DR .
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-1968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-921-2800
Provider Business Mailing Address Fax Number:
609-921-3499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 BUNN DR .
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-1968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-921-2800
Provider Business Practice Location Address Fax Number:
609-921-3499
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEATTIE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
609-921-2800

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 073126000 . This is a "INDEPENDENCE PERSONAL CHO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 073126000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 073126000 . This is a "BLUE SHIELD PENNSYLVANIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7634005 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE1559 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0529190 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 073126000 . This is a "KEYSTONE HEALTHPLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 515270 . This is a "AMERIHEALTH ADMINISTRATOR" identifier . This identifiers is of the category "OTHER".




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