| NPI | 1215363254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEKSANDR MARTIROSOV Owner 201-791-7771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2013-09-23 |