| NPI | 1346755402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MIRMANESH Medical Director 609-980-5672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2018-03-17 |