| NPI | 1508130873 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE ROBERTO Sole Member, Managing Member 973-981-5250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00301200) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2020-02-26 |