| NPI | 1437606100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE A SHAW Owner 609-469-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: NJ 25MA091266300) |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2016-09-09 |