| NPI | 1972932747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY TISCHLER President 347-242-6502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NJ 200040810) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2013-11-02 |