Provider Demographics
NPI:1780174482
Name:KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
Entity type:Organization
Organization Name:KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-651-4429
Mailing Address - Street 1:800 BUNN DR STE 304
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-651-4429
Mailing Address - Fax:
Practice Address - Street 1:12 E 44TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3624
Practice Address - Country:US
Practice Address - Phone:888-566-8774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty