| NPI | 1851355374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G COSTINO Owner 609-522-8358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MB02575800) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NJ MB02575800) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2008-01-31 |