| NPI | 1295005122 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANN TIEDEMANN Billing Agent 732-257-5454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 25MA06205300) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-18 |