Provider Demographics
NPI:1205447745
Name:PRINCETON LONGEVITY MEDICAL OF NEW YORK PLLC
Entity type:Organization
Organization Name:PRINCETON LONGEVITY MEDICAL OF NEW YORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-800-0752
Mailing Address - Street 1:104 CARNEGIE CTR STE 101
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6232
Mailing Address - Country:US
Mailing Address - Phone:888-800-0752
Mailing Address - Fax:
Practice Address - Street 1:1 WORLD TRADE CTR STE 71D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-0089
Practice Address - Country:US
Practice Address - Phone:888-800-0752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty