Provider Demographics
NPI:1437818085
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-853-7220
Mailing Address - Street 1:4 PRINCESS RD STE 207
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-243-0445
Mailing Address - Fax:609-844-1092
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-2192
Practice Address - Country:US
Practice Address - Phone:609-853-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty