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NPI Code Detail

MEDICARE: GARDEN STATE PHYSICIANS P.C.

MEDICARE: GARDEN STATE PHYSICIANS P.C.
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
1207Q00000XFamily Medicine PhysicianMB068932NJ
2207R00000XInternal Medicine PhysicianMA67505NJ

General Provider Information

NPI Number : 1518115542
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARDEN STATE PHYSICIANS P.C.
Provider Business Mailing Address
First Line : 10 JEFFERSON PLZ
Second Line : STE. 100
City : PRINCETON
State : NJ
Zip : 08540-9502
Country : US
Telephone Number : 732-274-1274
Fax Number : 732-355-0321
Provider Business Practice Location Address
First Line : 10 JEFFERSON PLZ
Second Line : STE. 100
City : PRINCETON
State : NJ
Zip : 08540-9542
Country : US
Telephone Number : 732-274-1274
Fax Number : 732-355-0321
Authorized Official
Title or Position : DIRECTOR
Name : SONIA DEORA
Credential : DO
Telephone Number : 732-274-1274
Provider Enumeration Date : 09/03/2008
Last Update Date : 10/08/2014

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Directions to “GARDEN STATE PHYSICIANS P.C. ” Practice Location

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