| NPI | 1770119919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEARL RAITZIK Otr/L 732-598-4309 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2020-03-19 |