Provider Demographics
NPI:1043538184
Name:PRINCETON PREMIER MEDICINE, LLC
Entity Type:Organization
Organization Name:PRINCETON PREMIER MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-1680
Mailing Address - Street 1:17 ROSEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1839
Mailing Address - Country:US
Mailing Address - Phone:609-921-1680
Mailing Address - Fax:609-921-3584
Practice Address - Street 1:281 WITHERSPOON STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542
Practice Address - Country:US
Practice Address - Phone:609-921-1680
Practice Address - Fax:609-921-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04680500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty