Provider Demographics
NPI:1215288089
Name:PRINCETON INTEGRAL ENDOCRINOLOGY, LLC
Entity type:Organization
Organization Name:PRINCETON INTEGRAL ENDOCRINOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:INMACULADA
Authorized Official - Last Name:BENITO-HERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-649-3161
Mailing Address - Street 1:43 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-3850
Mailing Address - Country:US
Mailing Address - Phone:609-252-0201
Mailing Address - Fax:
Practice Address - Street 1:20 NASSAU ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4509
Practice Address - Country:US
Practice Address - Phone:609-649-3161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08101000207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty