| NPI | 1154505907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEKSEY KRETOV Physician 732-414-2005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: NJ 25MA08294000) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: NJ 25MA08294000) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2023-04-21 |