| NPI | 1710060496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE A NIEBLOOM Doctor Administrative Director 973-736-7616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |