Healthcare Provider Details

I. General information

NPI: 1700349552
Provider Name (Legal Business Name): PDP ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 US HIGHWAY 1 BUILDING 16 SUITE 112
PRINCETON NJ
08540
US

IV. Provider business mailing address

7 BEAUMONT PL
WESTAMPTON NJ
08060-6729
US

V. Phone/Fax

Practice location:
  • Phone: 732-479-1519
  • Fax:
Mailing address:
  • Phone: 732-986-7663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: POONAM PATEL
Title or Position: OWNER
Credential: LPC
Phone: 732-479-1519