NPIMap

Organization Active NPI

Princeton/Corner House

  • Clinic/Center
  • Princeton, NJ
National Provider Identifier
1720145410
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
41140 Issued in NJ
Legal business name
PRINCETON/CORNER HOUSE
Practice address
1 Monument Dr
Princeton, NJ 08540-3406
Phone
(609) 924-8018
Fax
(609) 688-2045
NPI assigned
Jan 2, 2007
Last updated
Sep 16, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
PRINCETONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

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

Authorized official

Name
Mr. Gary J. De Blasio, MS, CEAP
Title
Executive Director
Phone
(609) 924-8018

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 41140 NJ Primary

Addresses

Primary practice location

1 Monument Dr
Princeton, NJ 08540-3406

Mailing address

1 Monument Dr
Princeton, NJ 08540-3036
Phone (609) 924-8018

Other identifiers 2

IdentifierTypeStateIssuer
0540358MedicaidNJ
0100200MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Princetoncorner House2 organizations share this tax ID, including this one
Part of
Princetoncorner House

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568592000000",
    "number": "1720145410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MONUMENT DR",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085403036",
            "telephone_number": "609-924-8018",
            "fax_number": "609-699-2045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MONUMENT DR",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085403406",
            "telephone_number": "609-924-8018",
            "fax_number": "609-688-2045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCETON/CORNER HOUSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRINCETON",
        "enumeration_date": "2007-01-02",
        "last_updated": "2019-09-16",
        "status": "A",
        "authorized_official_last_name": "DE BLASIO",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "609-924-8018",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, CEAP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NJ",
            "license": "41140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0540358",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100200",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; 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.