Provider Demographics
NPI:1720876477
Name:DEEPEN MEDICAL SERVICE
Entity type:Organization
Organization Name:DEEPEN MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SWETA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORADIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:732-824-2803
Mailing Address - Street 1:5 TANNER DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-9488
Mailing Address - Country:US
Mailing Address - Phone:732-824-2803
Mailing Address - Fax:
Practice Address - Street 1:5 TANNER DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-9488
Practice Address - Country:US
Practice Address - Phone:732-824-2803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service