| NPI | 1962157016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAYNA IACOVIELLO Billing Manager 732-935-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2022-03-16 |