Basic Information
| Provider Information | |||||||||
| NPI: | 1053725515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRINCETON MEDICAL AND BEHAVIORAL HEALTH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 957 ROUTE 33 | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | HAMILTON SQUARE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086902727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095851122 | ||||||||
| FaxNumber: | 6095850309 | ||||||||
| Practice Location | |||||||||
| Address1: | 957 ROUTE 33 | ||||||||
| Address2: | SUITE 390 | ||||||||
| City: | HAMILTON SQUARE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086902727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095851122 | ||||||||
| FaxNumber: | 6095850309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2014 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | MINA | ||||||||
| AuthorizedOfficialFirstName: | RANDA | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | JOINT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6095851122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.