| NPI | 1578966636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DEGEORGE Managing Member 908-347-7469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NJ MC04134) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2014-10-03 |