Provider Demographics
NPI:1568765931
Name:PRINCETON BONE AND JOINT, LLC
Entity Type:Organization
Organization Name:PRINCETON BONE AND JOINT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMIRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-750-1600
Mailing Address - Street 1:8 FORRESTAL ROAD SOUTH
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-750-1600
Mailing Address - Fax:609-750-1611
Practice Address - Street 1:8 FORRESTAL ROAD SOUTH
Practice Address - Street 2:SUITE 104
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-750-1600
Practice Address - Fax:609-750-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05135200261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1407872369OtherDR'S INDIVIDUAL NPI NUMBER
NJ0832707Medicaid
NJ157714Medicare PIN