Provider Demographics
NPI:1609288604
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:DR
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:917-838-2296
Mailing Address - Street 1:800 BUNN DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-955-4948
Mailing Address - Fax:
Practice Address - Street 1:800 BUNN DR
Practice Address - Street 2:SUITE 304
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1968
Practice Address - Country:US
Practice Address - Phone:609-955-4948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-24
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA083737002084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty