Provider Demographics
NPI:1659778181
Name:PRINCETON MEDICAL HOME
Entity Type:Organization
Organization Name:PRINCETON MEDICAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SARITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:REGULAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-274-2555
Mailing Address - Street 1:462 NEW RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2653
Mailing Address - Country:US
Mailing Address - Phone:732-274-2557
Mailing Address - Fax:732-274-6777
Practice Address - Street 1:462 NEW RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2653
Practice Address - Country:US
Practice Address - Phone:732-274-2557
Practice Address - Fax:732-274-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07959900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI48670Medicare UPIN
NJ126663Medicare PIN