| NPI | 1922212554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM MARIE FALLON Owner 732-281-1211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00062300) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |