Healthcare Provider Details

I. General information

NPI: 1629144720
Provider Name (Legal Business Name): PRINCETON HEALTHCARE SYSTEM A NEW JERSEY NON-PROFIT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLAINSBORO RD
PLAINSBORO NJ
08536-1913
US

IV. Provider business mailing address

1 PLAINSBORO RD
PLAINSBORO NJ
08536-1913
US

V. Phone/Fax

Practice location:
  • Phone: 609-853-6130
  • Fax: 609-853-6128
Mailing address:
  • Phone: 609-853-6130
  • Fax: 609-853-6128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00426800
License Number StateNJ

VIII. Authorized Official

Name: JAMES DEMETRIADES
Title or Position: VICE PRESIDENT
Credential: RPH
Phone: 609-853-6113