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General NPI Number Information
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NPI Number | 1720145410
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Entity Type | Organization
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Legal Business Name | PRINCETON/CORNER HOUSE
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 1 MONUMENT DR
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City | PRINCETON
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State | NJ
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Zip | 08540-3406
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Country | US
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Telephone | 609-924-8018
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Fax | 609-688-2045
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Provider Business Mailing Address
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Address Line | 1 MONUMENT DR
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City | PRINCETON
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State | NJ
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Zip | 08540-3036
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Country | US
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Telephone | 609-924-8018
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Fax | 609-699-2045
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GARY J. DE BLASIO
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Credential | MS, CEAP
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Telephone | 609-924-8018
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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 | 41140
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License Number State | NJ
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