| NPI | 1265037501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MITCHELL Director Of Credentialing 732-867-9618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 208000000X Pediatrics | |
| 2080A0000X Pediatrics, Adolescent Medicine | |
| 208D00000X General Practice | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2020-12-03 |