Provider Demographics
NPI:1629292842
Name:PRINCETON PULMONARY ASSOCIATES PC
Entity Type:Organization
Organization Name:PRINCETON PULMONARY ASSOCIATES PC
Other - Org Name:JOEL DEITZ MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:LOEB
Authorized Official - Last Name:DEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-688-9805
Mailing Address - Street 1:15 BOUVANT DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1208
Mailing Address - Country:US
Mailing Address - Phone:609-688-9805
Mailing Address - Fax:
Practice Address - Street 1:15 BOUVANT DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1208
Practice Address - Country:US
Practice Address - Phone:609-688-9805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA046885207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty