Healthcare Provider Details

I. General information

NPI: 1992759708
Provider Name (Legal Business Name): PRINCETON OCCUPATIONAL HEALTH & FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 ROUTE 33
HAMILTON NJ
08690-1749
US

IV. Provider business mailing address

2271 ROUTE 33
HAMILTON NJ
08690-1749
US

V. Phone/Fax

Practice location:
  • Phone: 609-584-0117
  • Fax:
Mailing address:
  • Phone: 609-584-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMA05743
License Number StateNJ

VIII. Authorized Official

Name: GLORIA CRUZ
Title or Position: PARTNER
Credential: M.D.
Phone: 609-584-0117