=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770607996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRINCETON OSTEOPOROSIS CENTER PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 02/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 281 WITHERSPOON ST SUITE 200
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-921-3331
-----------------------------------------------------
Fax | 609-252-0722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 281 WITHERSPOON ST SUITE 200
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-921-3331
-----------------------------------------------------
Fax | 609-252-0722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | LUZ J TORRES
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 609-921-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 23612
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------