Healthcare Provider Details

I. General information

NPI: 1619147485
Provider Name (Legal Business Name): PRINCETON MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3542 RTE 27
KENDALL PARK NJ
08824-1050
US

IV. Provider business mailing address

3542 RTE 27
KENDALL PARK NJ
08824-1050
US

V. Phone/Fax

Practice location:
  • Phone: 732-821-5562
  • Fax: 732-821-5347
Mailing address:
  • Phone: 732-821-5562
  • Fax: 732-821-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA075290
License Number StateNJ

VIII. Authorized Official

Name: BOBBY MALIK
Title or Position: ONWER/PRESIDENT
Credential: MD
Phone: 732-821-5562