| NPI | 1336363258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE M MAYES Director 201-200-0318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NJ MA72103) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: NJ MA69555) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-11-06 |