| NPI | 1720637150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMAN KOSIBOROD Owner/Operator 201-297-9517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2026-06-09 |