| NPI | 1376889980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESE E GRAY Counselor 973-953-5771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NJ 37PC00239500) |
| Additional Taxonomies | 251S00000X (Licence: NJ 37RC00244100) |
| Enumeration Date | 2012-12-31 |
| Last Update Date | 2012-12-31 |