| NPI | 1104634377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY WIMBERG VP Billing Operations 609-517-2526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2025-05-20 |