| NPI | 1730200841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNAMARIA CONKLIN Credentialing Coordinator 973-458-0422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25ma08164800) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2008-12-01 |