| NPI | 1124470786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMAN KOSIBOROD Medical Director 201-880-6204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NJ 25MB07566200) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2016-07-07 |