| NPI | 1730543216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY GOLDENBERG Owner 718-757-0199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NJ 38MC00682600) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2016-04-11 |