Healthcare Provider Details

I. General information

NPI: 1912407271
Provider Name (Legal Business Name): PRINCETON PSYCHIATRY & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EWING ST, SUITE C-10
PRINCETON NJ
08540
US

IV. Provider business mailing address

601 EWING ST, SUITE C-10
PRINCETON NJ
08540
US

V. Phone/Fax

Practice location:
  • Phone: 609-688-0400
  • Fax: 609-688-0401
Mailing address:
  • Phone: 609-688-0400
  • Fax: 609-688-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. DAVID L NATHAN
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 609-688-0400