| NPI | 1912041229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOWELL T TACLOB Doctor 973-523-0317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NJ 25MA02844600) |
| Additional Taxonomies | 261QE0700X Clinic/Center End-Stage Renal Disease (ESRD) Treatment (Licence: NJ 25MA02844600) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2020-08-22 |