| NPI | 1508128224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY DYER Practice Administrator 732-382-0091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: NJ 25MA06949800) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2012-06-12 |