| NPI | 1841678166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIOVANNA CORPORAN Credential Coordinator 201-475-0019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NJ 25MP00085800) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |