Provider Demographics
NPI:1194825489
Name:PROFESSIONAL HEALTHCARE SERVICES OF LAWRENCEVILLE
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE SERVICES OF LAWRENCEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-771-6660
Mailing Address - Street 1:2500 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4134
Mailing Address - Country:US
Mailing Address - Phone:609-771-6660
Mailing Address - Fax:609-530-0966
Practice Address - Street 1:2500 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4134
Practice Address - Country:US
Practice Address - Phone:609-771-6660
Practice Address - Fax:609-530-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ767164Medicare ID - Type Unspecified