Healthcare Provider Details

I. General information

NPI: 1467835793
Provider Name (Legal Business Name): PRINCETON HEALTHCARE AFFILIATED PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 PENNINGTON RD
EWING NJ
08618-1301
US

IV. Provider business mailing address

4 PRINCESS RD SUITE 207
LAWRENCEVILLE NJ
08648-2322
US

V. Phone/Fax

Practice location:
  • Phone: 609-883-4124
  • Fax: 609-883-0031
Mailing address:
  • Phone: 609-243-0445
  • Fax: 609-844-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN R BERGMANN
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 609-853-7220