| NPI | 1790145852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERTUANA JORGES Director 973-342-9106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 261QR0401X) |
| Enumeration Date | 2016-03-02 |
| Last Update Date | 2016-03-02 |