| NPI | 1659601789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY MABAGOS Owner 732-279-6537 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NJ 25MA06682500) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: NJ 25MA06682500) |
| 305R00000X Preferred Provider Organization (Licence: NJ 25MA06682500) | |
| 305S00000X Point of Service (Licence: NJ 25MA06682500) | |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2010-01-13 |