NPIMap

Organization Active NPI

Princeton Healthcare Provider Group LLC

Doing business as Bristol Myers Squibb Community Health Clinic-Pediatric Clinic

  • Pediatrics Physician
  • Plainsboro, NJ
National Provider Identifier
1629286000
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PRINCETON HEALTHCARE PROVIDER GROUP LLC
Doing business as
Bristol Myers Squibb Community Health Clinic-Pediatric Clinic
Practice address
1 Plainsboro Rd
Plainsboro, NJ 08536-1913
Phone
(609) 853-7600
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
Sr Vice President, Chief Financial
Phone
(609) 853-7107

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1 Plainsboro Rd
Plainsboro, NJ 08536-1913

Mailing address

PO Box 824320
Philadelphia, PA 19182-4320
Phone (800) 406-1177

Other identifiers 1

IdentifierTypeStateIssuer
6172300MedicaidNJ

Other names 1

  • Bristol Myers Squibb Community Health Clinic-Pediatric Clinic Doing business as

National Provider Directory

National Provider Directory

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": "1629286000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824320",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191824320",
            "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 RD",
            "city": "PLAINSBORO",
            "state": "NJ",
            "postal_code": "085361913",
            "telephone_number": "609-853-7600",
            "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": "SR VICE PRESIDENT, CHIEF FINANCIAL",
        "authorized_official_telephone_number": "609-853-7107"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6172300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bristol Myers Squibb Community Health Clinic-Pediatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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.