Healthcare Provider Details

I. General information

NPI: 1376180679
Provider Name (Legal Business Name): PRENTGRAF LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 ALEXANDER PARK DRIVE SUITE 101
PRINCETON NJ
08540
US

IV. Provider business mailing address

PO BOX 1753
VOORHEES NJ
08043
US

V. Phone/Fax

Practice location:
  • Phone: 855-274-9582
  • Fax:
Mailing address:
  • Phone: 855-274-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ADRIAN PELLEW
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 855-274-9582