Provider Demographics
NPI:1316314859
Name:PRINCETON HEALTHCARE PROVIDER GROUP LLC
Entity type:Organization
Organization Name:PRINCETON HEALTHCARE PROVIDER GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:DENNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-853-7108
Mailing Address - Street 1:4 PRINCESS RD
Mailing Address - Street 2:STE 207
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-243-0445
Mailing Address - Fax:609-844-1092
Practice Address - Street 1:1 PLAINSBORO RD
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-1913
Practice Address - Country:US
Practice Address - Phone:609-853-7276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCEOTN HEALTHCARE PROVIDER GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty