| NPI | 1659042331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE TERRERO Ser. Director Provider Data Mngmt 201-667-5568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2023-11-21 |