| NPI | 1811394240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOUSEF ABDULMISAH Incorporator 973-928-3342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NJ 25MA06251200) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |