| NPI | 1740734524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL FERNANDEZ President 732-826-4177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NJ 03550900) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2016-08-09 |