| NPI | 1003453051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETTIE TRESS Administrator 732-987-3855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2023-06-22 |