Provider Demographics
NPI:1154353902
Name:PRINCETON INTERVENTIONAL CARDIOLOGY PA
Entity type:Organization
Organization Name:PRINCETON INTERVENTIONAL CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEATTIE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-2800
Mailing Address - Street 1:800 BUNN DR .
Mailing Address - Street 2:STE 101
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-921-2800
Mailing Address - Fax:609-921-3499
Practice Address - Street 1:800 BUNN DR .
Practice Address - Street 2:STE 101
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1968
Practice Address - Country:US
Practice Address - Phone:609-921-2800
Practice Address - Fax:609-921-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
073126000OtherINDEPENDENCE PERSONAL CHO
073126000OtherAMERIHEALTH HMO
073126000OtherBLUE SHIELD PENNSYLVANIA
NJ7634005Medicaid
CE1559OtherMEDICARE RAILROAD
0529190OtherAETNA US HEALTHCARE
073126000OtherKEYSTONE HEALTHPLANS
515270OtherAMERIHEALTH ADMINISTRATOR
0529190OtherAETNA US HEALTHCARE
073126000OtherINDEPENDENCE PERSONAL CHO
515270OtherAMERIHEALTH ADMINISTRATOR
=========OtherHORIZON BLUE CROSS BLUE S
NJ7634005Medicaid
=========OtherCHN
=========OtherMULTIPLAN
=========OtherAARP HEALTH INSURANCE
CE1559OtherMEDICARE RAILROAD
=========OtherGREAT WEST
=========OtherHORIZON BLUE CROSS BLUE S