Provider Demographics
NPI:1417901521
Name:PRINCETON NASSAU PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:PRINCETON NASSAU PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:NADDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-3410
Mailing Address - Street 1:301 N HARRISON ST
Mailing Address - Street 2:PRINCETON SHOPPING CENTER
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3512
Mailing Address - Country:US
Mailing Address - Phone:609-921-3441
Mailing Address - Fax:609-921-3441
Practice Address - Street 1:301 N HARRISON ST
Practice Address - Street 2:PRINCETON SHOPPING CENTER
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3512
Practice Address - Country:US
Practice Address - Phone:609-921-3441
Practice Address - Fax:609-921-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty