Provider Demographics
NPI:1982809604
Name:PRINCETON LONGEVITY MEDICAL GRP LLC
Entity Type:Organization
Organization Name:PRINCETON LONGEVITY MEDICAL GRP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-800-0752
Mailing Address - Street 1:136 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-5735
Mailing Address - Country:US
Mailing Address - Phone:888-800-0752
Mailing Address - Fax:609-430-8470
Practice Address - Street 1:136 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5735
Practice Address - Country:US
Practice Address - Phone:888-800-0752
Practice Address - Fax:609-430-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty