Provider Demographics
NPI:1750627907
Name:PRINCETON HEALTH ASSOCIATES PC
Entity Type:Organization
Organization Name:PRINCETON HEALTH ASSOCIATES PC
Other - Org Name:PREMIER PRIMARY CARE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEER
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-823-2221
Mailing Address - Street 1:3 HOSPITAL PLZ STE 203
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3084
Mailing Address - Country:US
Mailing Address - Phone:732-823-2221
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL PLZ STE 203
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3084
Practice Address - Country:US
Practice Address - Phone:732-823-2221
Practice Address - Fax:609-619-4813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08756300261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care