| NPI | 1073525614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE MANGONE Authorized Official 973-614-8484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MB03219800) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2008-04-20 |