| NPI | 1134348527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAIS MAMBERG Doctor 302-428-0337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: DE 207v00000x) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2008-06-19 |