| NPI | 1326919655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCAS JOHNSTON Operations Administrator 973-270-3396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| 2080S0010X Pediatrics Sports Medicine | |
| 208100000X Physical Medicine & Rehabilitation | |
| 2081P0301X Physical Medicine & Rehabilitation Brain Injury Medicine | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 2084P0301X Psychiatry & Neurology Brain Injury Medicine | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2025-09-17 |