| NPI | 1740328608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA BENIQUEZ PACHECO Credentialing Supervisor 201-833-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2024-05-08 |