Provider Demographics
NPI:1285842823
Name:PRINCETON HEALTHCARE PROVIDER GROUP LLC
Entity Type:Organization
Organization Name:PRINCETON HEALTHCARE PROVIDER GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GUILHERME
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-853-7107
Mailing Address - Street 1:PO BOX 824320
Mailing Address - Street 2:
Mailing Address - City:PHILIDELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182
Mailing Address - Country:US
Mailing Address - Phone:800-406-1177
Mailing Address - Fax:609-844-1092
Practice Address - Street 1:1 PLAINSBORO ROAD
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536
Practice Address - Country:US
Practice Address - Phone:609-853-7619
Practice Address - Fax:609-853-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7767200Medicaid