MEDICARE: PRINCETON CHILD DEVELOPMENT INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1588523914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON CHILD DEVELOPMENT INSTITUTE

Provider Business Mailing Address
First Line	:	4374 PROVINCE LINE ROAD
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540
Country	:	US
Telephone Number	:	609-924-6280
Fax Number	:

Provider Business Practice Location Address
First Line	:	4374 PROVINCE LINE ROAD
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540
Country	:	US
Telephone Number	:	609-924-6280
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	NANCY L GALLAGHER
Credential	:
Telephone Number	:	609-924-6280

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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