Provider Demographics
NPI:1053725515
Name:PRINCETON MEDICAL AND BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:PRINCETON MEDICAL AND BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JOINT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-585-1122
Mailing Address - Street 1:957 ROUTE 33
Mailing Address - Street 2:SUITE 390
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-2727
Mailing Address - Country:US
Mailing Address - Phone:609-585-1122
Mailing Address - Fax:609-585-0309
Practice Address - Street 1:957 ROUTE 33
Practice Address - Street 2:SUITE 390
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-2727
Practice Address - Country:US
Practice Address - Phone:609-585-1122
Practice Address - Fax:609-585-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty