Healthcare Provider Details

I. General information

NPI: 1154553063
Provider Name (Legal Business Name): GERIATRIC TREATMENT RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRANKLIN CORNER RD STE 204
LAWRENCE TOWNSHIP NJ
08648-2526
US

IV. Provider business mailing address

12 BAILEY DR
PRINCETON NJ
08540-7955
US

V. Phone/Fax

Practice location:
  • Phone: 609-730-1888
  • Fax:
Mailing address:
  • Phone: 609-744-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PRITI S GUJAR
Title or Position: PRESIDENT
Credential: MD
Phone: 609-744-5754