Healthcare Provider Details

I. General information

NPI: 1659778181
Provider Name (Legal Business Name): PRINCETON MEDICAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 NEW RD
MONMOUTH JUNCTION NJ
08852-2653
US

IV. Provider business mailing address

462 NEW RD
MONMOUTH JUNCTION NJ
08852-2653
US

V. Phone/Fax

Practice location:
  • Phone: 732-274-2557
  • Fax: 732-274-6777
Mailing address:
  • Phone: 732-274-2557
  • Fax: 732-274-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07959900
License Number StateNJ

VIII. Authorized Official

Name: SARITHA REGULAPATI
Title or Position: MD
Credential: M.D.
Phone: 732-274-2555