| NPI | 1326477027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIEZER SANTIAGO Progrma Administrator 732-410-7102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: NJ 2000575) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2019-01-17 |