Provider Demographics
NPI:1073519591
Name:PRINCETON PIKE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:PRINCETON PIKE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-896-1793
Mailing Address - Street 1:3100 PRINCETON PIKE
Mailing Address - Street 2:BUILDING 3, 3RD FLOOR
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-896-1793
Mailing Address - Fax:609-896-1847
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BLDG 3, 3RD FLOOR
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:609-896-1793
Practice Address - Fax:609-896-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
039529Medicare PIN