| NPI | 1598928517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELCHIORRE JOSEPH RUSSO Owner 973-279-5116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA04879600) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2021-05-12 |