| NPI | 1962772483 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C RUSSONELLA Owner 973-340-1940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NJ 25MA08676900) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2016-04-04 |