| NPI | 1003566134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE WINANT Credentialing Supervisor 732-570-0268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2023-09-20 |