Provider Demographics
NPI:1679810105
Name:PRINCETON CHILD DEVELOPMENT INSTITUTE
Entity type:Organization
Organization Name:PRINCETON CHILD DEVELOPMENT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FENSKE
Authorized Official - Suffix:
Authorized Official - Credentials:MAT, EDS
Authorized Official - Phone:609-924-6280
Mailing Address - Street 1:300 COLD SOIL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2002
Mailing Address - Country:US
Mailing Address - Phone:609-924-6280
Mailing Address - Fax:
Practice Address - Street 1:300 COLD SOIL RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2002
Practice Address - Country:US
Practice Address - Phone:609-924-6280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health