| NPI | 1114871886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIVIEN OGON Credentialing Manager 856-398-0428 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2026-02-20 |
| Last Update Date | 2026-05-12 |