MEDICARE: PRINCETON PULMONARY ASSOCIATES PC

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	207RP1001X	Pulmonary Disease Physician	MA046885	NJ

General Provider Information

NPI Number	:	1629292842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCETON PULMONARY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	15 BOUVANT DR
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-1208
Country	:	US
Telephone Number	:	609-688-9805
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 BOUVANT DR
Second Line	:
City	:	PRINCETON
State	:	NJ
Zip	:	08540-1208
Country	:	US
Telephone Number	:	609-688-9805
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOEL LOEB DEITZ
Credential	:	MD
Telephone Number	:	609-688-9805

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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