| NPI | 1750875589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTONIO CICCONE Medical Director 973-751-2060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NJ 25MB05752300) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2018-06-15 |