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General NPI Number Information
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NPI Number | 1063629814
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Entity Type | Organization
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Legal Business Name | PRINCETON HEART GROUP
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 253 WITHERSPOON ST
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City | PRINCETON
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State | NJ
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Zip | 08540-3211
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Country | US
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Telephone | 609-734-7600
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Fax | 609-844-1092
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Provider Business Mailing Address
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Address Line | 4 PRINCESS RD SUITE #207
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2322
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Country | US
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Telephone | 609-734-7600
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Fax | 609-844-1092
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Authorized Official
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Title or Position | CFO
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Name | BRUCE TRAUB
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Credential | RESPONSIBLE MANANGME
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Telephone | 609-734-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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