| NPI | 1013940006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES R MORALES Owner 732-255-3877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ 25MA06900500) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MB08376900) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2010-06-14 |