| NPI | 1861648180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS J. GOMEZ Director 201-823-2655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NJ MA22874) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2008-08-18 |