Facts
- Status
- A
- Credential
- APN
- Type
- Individual
- Enumeration date
- 2018-09-19
- Last updated
- 2018-09-19
Specialties
Licenses
- License NJ
- 26NJ00835900
Location
- Practice location
- 112 MILLBROOK RD
- City
- HARDWICK NJ
- Postal code
- 078259531
- Phone
- 973-534-1966
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.