| NPI | 1114472727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMENLINO C PAYUMO President 732-826-4177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NJ 25MA02902600) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2016-08-24 |