| NPI | 1891090858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE DACOSTA A Md 973-674-8866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NJ 25MA05600200) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA07916100) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |