Healthcare Provider Details

I. General information

NPI: 1861669244
Provider Name (Legal Business Name): PRINCETON ROAD PEDIATRICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 PRINCETON HIGHTSTOWN ROAD SUITE 4
EAST WINDSOR NJ
08520
US

IV. Provider business mailing address

251 PRINCETON HIGHTSTOWN ROAD SUITE 4
EAST WINDSOR NJ
08520
US

V. Phone/Fax

Practice location:
  • Phone: 609-448-8280
  • Fax: 609-395-1978
Mailing address:
  • Phone: 609-448-8280
  • Fax: 609-395-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03948900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA03948900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMA015133
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number25MA03948900
License Number StateNJ

VIII. Authorized Official

Name: MS. DENISE ALICIA GARCIA
Title or Position: SITE/BILLING MANAGER
Credential:
Phone: 609-448-8280