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General NPI Number Information
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NPI Number | 1114464443
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Entity Type | Organization
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Legal Business Name | PRINCETON BIOFEEDBACK CENTRE, LLC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 317 MOUNT LUCAS RD
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City | PRINCETON
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State | NJ
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Zip | 08540-2701
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Country | US
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Telephone | 609-924-0782
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Fax |
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Provider Business Mailing Address
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Address Line | 317 MOUNT LUCAS RD
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City | PRINCETON
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State | NJ
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Zip | 08540-2701
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Country | US
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Telephone | 609-924-0782
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LESTER FEHMI
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Credential | PH.D.
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Telephone | 609-924-0782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00113500
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License Number State | NJ
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