| NPI | 1720709629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN KACZKA Mbmr 908-948-8802 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2022-10-14 |