| NPI | 1043979842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE TERRERO Sr. Director Of Provider Data Mngmt 201-667-5568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 104100000X Social Worker |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2023-11-21 |