Provider Demographics
NPI:1538705835
Name:KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
Entity Type:Organization
Organization Name:KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-651-4429
Mailing Address - Street 1:800 BUNN DR STE 304
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:888-566-8774
Mailing Address - Fax:
Practice Address - Street 1:357 S GULPH RD STE 260
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3174
Practice Address - Country:US
Practice Address - Phone:888-566-8774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty