| LLC | |
|
123 Franklin Corner Rd Suite 204 Lawrenceville NJ 08648-2526 | |
| (609) 844-0084 | |
| (609) 844-0085 |
| Full Name | LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 123 Franklin Corner Rd, Lawrenceville, New Jersey |
| Authorized Official Name and Position | Diane Warner Gaukler-george (OFFICE MANAGER) |
| Authorized Official Contact | 6098440083 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| LLC 123 Franklin Corner Rd Suite 204 Lawrenceville NJ 08648-2526 Ph: (609) 844-0084 | LLC 123 Franklin Corner Rd Suite 204 Lawrenceville NJ 08648-2526 Ph: (609) 844-0084 |
| NPI Number | 1528070901 |
|---|---|
| Provider Enumeration Date | 08/13/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528070901 | NPI | - | NPPES |
| 2460904 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD 044787L (New Jersey) | Secondary |
| 207R00000X | Internal Medicine | MA 049502 (New Jersey) | Primary |
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