| NPI | 1245580653 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MA. OLIVIA ROQUE SAN DIEGO Director 973-653-6119 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 036-130487) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2012-09-12 |