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General NPI Number Information
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NPI Number | 1538885173
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Entity Type | Organization
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Legal Business Name | MIRTH HEALTH SYSTEMS LLC
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 194 N HARRISON ST
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City | PRINCETON
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State | NJ
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Zip | 08540-3516
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Country | US
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Telephone | 609-445-3315
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 293
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City | PRINCETON
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State | NJ
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Zip | 08542-0293
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Country | US
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Telephone | 312-731-7525
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | DR. OLUWABUKOLA PRINCESS ADASOFUNJO
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Credential | MD
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Telephone | 609-445-3315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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