1467835793 NPI number — PRINCETON HEALTHCARE AFFILIATED PHYSICIANS PC

Table of content: (NPI 1467835793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467835793 NPI number — PRINCETON HEALTHCARE AFFILIATED PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINCETON HEALTHCARE AFFILIATED PHYSICIANS PC
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:
6
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:
1467835793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2020
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:
1539 PENNINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08618-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-883-4124
Provider Business Practice Location Address Fax Number:
609-883-0031
Provider Enumeration Date:
07/06/2015

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: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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