| NPI | 1376674572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS TELLO Medical Irector 973-345-7113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NJ 25MA04703100) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA04703100) |
| 2086S0129X Surgery, Vascular Surgery (Licence: NJ 25MA04703100) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-01-12 |