| NPI | 1700529815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDEN STALLER Doctor 732-874-6063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-04-16 |
| Last Update Date | 2023-06-22 |