Provider Demographics
NPI:1841588795
Name:PRINCETON NEUROMUSCULAR CENTER, PC
Entity Type:Organization
Organization Name:PRINCETON NEUROMUSCULAR CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-421-7070
Mailing Address - Street 1:13 CLYDE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5037
Mailing Address - Country:US
Mailing Address - Phone:732-421-7070
Mailing Address - Fax:
Practice Address - Street 1:13 CLYDE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5037
Practice Address - Country:US
Practice Address - Phone:732-421-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty