| NPI | 1215288386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBALAVANER KRISHNAMOORTHY Physician Director 908-753-5771 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ MA53719) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA44629) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |