| NPI | 1417967456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON T ELLISTON Medical Director 201-478-5800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NJ 24089) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2025-11-06 |