| NPI | 1952899957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ANN RUSSOMANO Registered Agent/Member/Manager 908-851-0455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2023-01-10 |