Basic Information
| Provider Information | |||||||||
| NPI: | 1457393258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRINCETON BRAIN & SPINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157413141 | ||||||||
| FaxNumber: | 2157413143 | ||||||||
| Practice Location | |||||||||
| Address1: | 1205 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157413141 | ||||||||
| FaxNumber: | 2157413143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | MCLAUGHLIN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2157413141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA07347600 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.