Provider Demographics
NPI:1639124480
Name:PRINCETON HYPERTENSION NEPHROLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:PRINCETON HYPERTENSION NEPHROLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-750-7330
Mailing Address - Street 1:88 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1100
Mailing Address - Country:US
Mailing Address - Phone:609-750-7330
Mailing Address - Fax:609-750-7336
Practice Address - Street 1:88 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1100
Practice Address - Country:US
Practice Address - Phone:609-750-7330
Practice Address - Fax:609-750-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty