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General NPI Number Information
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NPI Number | 1720876477
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Entity Type | Organization
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Legal Business Name | DEEPEN MEDICAL SERVICE
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 5 TANNER DR
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City | PRINCETON
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State | NJ
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Zip | 08540-9488
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Country | US
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Telephone | 732-824-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 5 TANNER DR
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City | PRINCETON
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State | NJ
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Zip | 08540-9488
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Country | US
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Telephone | 732-824-2803
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SWETA GORADIA
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Credential | PA-C
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Telephone | 732-824-2803
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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