Provider Demographics
NPI:1093011835
Name:PRINCETON PREMIER MEDICINE LLC
Entity Type:Organization
Organization Name:PRINCETON PREMIER MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-1680
Mailing Address - Street 1:800 BUNN DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-921-1680
Mailing Address - Fax:609-921-1438
Practice Address - Street 1:800 BUNN DR
Practice Address - Street 2:SUITE 302
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1968
Practice Address - Country:US
Practice Address - Phone:609-921-1680
Practice Address - Fax:609-921-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0468500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherFEDERAL TAX ID# FOR PRINCETON PREMIER MEDICINE, LLC
NJ885917Medicare PIN
D20074Medicare UPIN
NJ212751Medicare PIN