| NPI | 1881927358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED S REVOREDO President 973-345-4024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA07147400) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NJ 25MA07147400) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2009-09-15 |