| NPI | 1356484687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE FITZPATRICK Billing Representative 800-572-0809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA61656) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ MA61656) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2011-05-25 |