| NPI | 1932640380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASYA RIVINSON Owner 800-870-6244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NJ 44SC05647900) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NY 079083) |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2017-03-19 |