Healthcare Provider Details

I. General information

NPI: 1285842823
Provider Name (Legal Business Name): PRINCETON HEALTHCARE PROVIDER GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLAINSBORO ROAD
PLAINSBORO NJ
08536
US

IV. Provider business mailing address

PO BOX 824320
PHILIDELPHIA PA
19182
US

V. Phone/Fax

Practice location:
  • Phone: 609-853-7619
  • Fax: 609-853-7602
Mailing address:
  • Phone: 800-406-1177
  • Fax: 609-844-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GUILHERME VALLADARES
Title or Position: SVP, CHIEF FINANCIAL OFFICER
Credential:
Phone: 609-853-7107