Provider Demographics
NPI:1659304178
Name:PRINCETON AND RUTGER NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:PRINCETON AND RUTGER NEUROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEFBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-246-1311
Mailing Address - Street 1:51 VERONICA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3448
Mailing Address - Country:US
Mailing Address - Phone:732-246-1311
Mailing Address - Fax:732-246-3501
Practice Address - Street 1:51 VERONICA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3448
Practice Address - Country:US
Practice Address - Phone:732-246-1311
Practice Address - Fax:732-246-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN
NJ=========OtherTIN