MEDICARE: PRINCETON MEDICAL CARE LLC

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	25MA075290	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619147485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON MEDICAL CARE LLC

Provider Business Mailing Address
First Line	:	3542 RTE 27
Second Line	:
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-1050
Country	:	US
Telephone Number	:	732-821-5562
Fax Number	:	732-821-5347

Provider Business Practice Location Address
First Line	:	3542 RTE 27
Second Line	:
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-1050
Country	:	US
Telephone Number	:	732-821-5562
Fax Number	:	732-821-5347

Authorized Official
Title or Position	:	ONWER/PRESIDENT
Name	:	BOBBY MALIK
Credential	:	MD
Telephone Number	:	732-821-5562

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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