| NPI | 1700465457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROTH RILEY Director 908-258-7014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-07-20 |