Provider Demographics
NPI:1548029788
Name:PRINCETON THERANOSTICS, PC
Entity type:Organization
Organization Name:PRINCETON THERANOSTICS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SABOURY SICHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-720-6356
Mailing Address - Street 1:8300 NORMAN CENTER DR STE 160
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 FORRESTAL RD S STE 201
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6658
Practice Address - Country:US
Practice Address - Phone:612-431-1898
Practice Address - Fax:612-662-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty