| NPI | 1346231255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY A. GOLLOUB Owner 973-334-9404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ MA55345) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ MA55345) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2018-03-13 |