| NPI | 1306016050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN S WALLACH Owner/Physician 856-767-1026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB01786500) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NJ MB017865) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2010-09-15 |