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General NPI Number Information
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NPI Number | 1275885170
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Entity Type | Organization
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Legal Business Name | PRINCETON SLEEP MEDICINE GROUP, P.C.
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 1675 WHITEHORSE MERCERVILLE RD SUITE 105
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City | HAMILTON
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State | NJ
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Zip | 08619-3825
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Country | US
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Telephone | 856-222-9585
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Fax | 856-222-9585
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Provider Business Mailing Address
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Address Line | 4 LEEDS RD
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City | MOORESTOWN
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State | NJ
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Zip | 08057-1884
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Country | US
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Telephone | 609-955-2576
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Fax | 856-222-9585
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DANA SUPE
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Credential | MD
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Telephone | 609-955-2576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | BS5438115
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License Number State | NJ
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