Provider Demographics
NPI:1073171062
Name:PRINCETON BRAIN & SPINE, LLC
Entity Type:Organization
Organization Name:PRINCETON BRAIN & SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-9001
Mailing Address - Street 1:190 STATE ROUTE 31 STE 300B
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5763
Mailing Address - Country:US
Mailing Address - Phone:908-229-6627
Mailing Address - Fax:
Practice Address - Street 1:190 STATE ROUTE 31 STE 300B
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5763
Practice Address - Country:US
Practice Address - Phone:908-229-6627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies