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 |