| NPI | 1174981484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES G HADDAD Member/ Manager 973-779-7979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00383100) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2016-02-01 |