| NPI | 1255636213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS I. KELLY Contracted Manager 201-620-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2013-04-26 |