| NPI | 1336350909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY M BLAKE CEO 201-451-5425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker Clinical | |
| 133NN1002X Nutritionist Nutrition, Education | |
| 133V00000X Dietitian, Registered | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QM2800X Clinic/Center Methadone (Licence: NJ 22613) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-10-06 |