Provider Demographics
NPI:1619147485
Name:PRINCETON MEDICAL CARE LLC
Entity Type:Organization
Organization Name:PRINCETON MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-821-5562
Mailing Address - Street 1:3542 RTE 27
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1050
Mailing Address - Country:US
Mailing Address - Phone:732-821-5562
Mailing Address - Fax:732-821-5347
Practice Address - Street 1:3542 RTE 27
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1050
Practice Address - Country:US
Practice Address - Phone:732-821-5562
Practice Address - Fax:732-821-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075290207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ911590Medicaid
NJ911590Medicaid
NJ067732Medicare PIN