| NPI | 1740924687 |
|---|---|
| Former Legal Business Name | IM SO YOGA NEWARK |
| Entity Type | Organization |
| Authorized Contact | LESLIE L HERNANDEZ CEO 862-236-3376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X | |
| 302R00000X Health Maintenance Organization | |
| 305S00000X Point of Service | |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-04-26 |