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General NPI Number Information
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NPI Number | 1609288604
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Entity Type | Organization
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Legal Business Name | KETAMINE TREATMENT CENTERS OF PRINCETON, LLC
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Dates
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Enumeration Date | 05/24/2014
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Last Update Date | 06/14/2019
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Provider Practice Location Address
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Address Line | 800 BUNN DR SUITE 304
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City | PRINCETON
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State | NJ
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Zip | 08540-1968
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Country | US
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Telephone | 609-955-4948
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Fax |
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Provider Business Mailing Address
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Address Line | 800 BUNN DR SUITE 304
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City | PRINCETON
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State | NJ
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Zip | 08540-1968
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Country | US
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Telephone | 609-955-4948
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. STEVEN P LEVINE
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Credential | M.D.
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Telephone | 917-838-2296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA08373700
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License Number State | NJ
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