| NPI | 1528557063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDRE SHIVRATTAN Credentialing Specialist 347-579-5159 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NJ 22DI01842800) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2018-05-09 |