Organization
PRINCETON/CORNER HOUSE
Active
Parent organization
PRINCETON
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRINCETON
Authorized official
MR. GARY J. DE BLASIO MS, CEAP (EXECUTIVE DIRECTOR)
(609) 924-8018
Entity
Organization
Contact information
Practice address
1 MONUMENT DR, PRINCETON, NJ 08540-3406
(609) 924-8018
(609) 688-2045
Mailing address
1 MONUMENT DR, PRINCETON, NJ 08540-3036
(609) 924-8018
(609) 699-2045
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
41140
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0100200
—
NJ
05
—
0540358
—
NJ
Enumeration date
01/02/2007
Last updated
09/16/2019
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