| NPI | 1316294572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CUSTIS Sole Proprietor 732-264-2224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08719200) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2013-08-26 |