Provider Demographics
NPI:1114464443
Name:PRINCETON BIOFEEDBACK CENTRE, LLC
Entity Type:Organization
Organization Name:PRINCETON BIOFEEDBACK CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:FEHMI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-924-0782
Mailing Address - Street 1:317 MOUNT LUCAS RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2701
Mailing Address - Country:US
Mailing Address - Phone:609-924-0782
Mailing Address - Fax:
Practice Address - Street 1:317 MOUNT LUCAS RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2701
Practice Address - Country:US
Practice Address - Phone:609-924-0782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00113500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty