Provider Demographics
NPI:1063629814
Name:PRINCETON HEART GROUP
Entity Type:Organization
Organization Name:PRINCETON HEART GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:RESPONSIBLE MANANGME
Authorized Official - Phone:609-734-7600
Mailing Address - Street 1:4 PRINCESS RD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-734-7600
Mailing Address - Fax:609-844-1092
Practice Address - Street 1:253 WITHERSPOON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3211
Practice Address - Country:US
Practice Address - Phone:609-734-7600
Practice Address - Fax:609-844-1092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6120806Medicaid
NJ684227Medicare ID - Type Unspecified