Provider Demographics
NPI:1598442600
Name:PRINCETON CARDIOMETABOLIC HEALTH LLC
Entity Type:Organization
Organization Name:PRINCETON CARDIOMETABOLIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MODARRESSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-951-3944
Mailing Address - Street 1:21 ROUTE 31 N STE B6
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1621
Mailing Address - Country:US
Mailing Address - Phone:609-951-3944
Mailing Address - Fax:
Practice Address - Street 1:21 ROUTE 31 N STE B6
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1621
Practice Address - Country:US
Practice Address - Phone:609-951-3944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty