| 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 |