NPI | 1912678012 |
---|---|
Entity Type | Organization |
Authorized Contact | JAMIE TERRERO Sr Director Provider Data Mngmt 201-667-5568 |
Organization Subpart ? | No |
Primary Taxonomy | 208D00000X General Practice |
Additional Taxonomies | 363A00000X Physician Assistant |
363L00000X Nurse Practitioner | |
104100000X Social Worker | |
Enumeration Date | 2021-09-28 |
Last Update Date | 2023-11-21 |