| NPI | 1588053706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENALYN CANULLAS Program Coordinator 732-500-1477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2015-02-25 |