NPIMap

Organization Active NPI

Princeton Healthcare Provider Group LLC

  • Internal Medicine Physician
  • Plainsboro, NJ
National Provider Identifier
1285842823
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PRINCETON HEALTHCARE PROVIDER GROUP LLC
Practice address
1 Plainsboro Road
Plainsboro, NJ 08536
Phone
(609) 853-7619
Fax
(609) 853-7602
NPI assigned
May 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Guilherme Valladares
Title
SVP, Chief Financial Officer
Phone
(609) 853-7107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1 Plainsboro Road
Plainsboro, NJ 08536

Mailing address

PO Box 824320
Philidelphia, PA 19182
Phone (800) 406-1177

Other identifiers 1

IdentifierTypeStateIssuer
7767200MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Princeton HLTH Provider GRP4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

253 Witherspoon St
Ste B
Princeton, NJ 08540

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620259200000",
    "number": "1285842823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824320",
            "city": "PHILIDELPHIA",
            "state": "PA",
            "postal_code": "19182",
            "telephone_number": "800-406-1177",
            "fax_number": "609-844-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PLAINSBORO ROAD",
            "city": "PLAINSBORO",
            "state": "NJ",
            "postal_code": "08536",
            "telephone_number": "609-853-7619",
            "fax_number": "609-853-7602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCETON HEALTHCARE PROVIDER GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "VALLADARES",
        "authorized_official_first_name": "GUILHERME",
        "authorized_official_title_or_position": "SVP, CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "609-853-7107"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7767200",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainsboro, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.