NPI | 1598291593 |
---|---|
Entity Type | Organization |
Authorized Contact | CHARLES K GLEASON Owner 201-444-0111 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NJ 40QA01130200) |
Enumeration Date | 2017-05-11 |
Last Update Date | 2017-05-11 |