MEDICARE: PRINCETON PIKE INTERNAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		NJ

General Provider Information

NPI Number	:	1073519591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON PIKE INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	3100 PRINCETON PIKE
Second Line	:	BUILDING 3, 3RD FLOOR
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2300
Country	:	US
Telephone Number	:	609-896-1793
Fax Number	:	609-896-1847

Provider Business Practice Location Address
First Line	:	3100 PRINCETON PIKE
Second Line	:	BLDG 3, 3RD FLOOR
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2300
Country	:	US
Telephone Number	:	609-896-1793
Fax Number	:	609-896-1847

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. JOANNE SUDOL
Credential	:
Telephone Number	:	609-896-1793

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/21/2022

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Directions to “PRINCETON PIKE INTERNAL MEDICINE ” Practice Location

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