Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2006-12-06
- Last updated
- 2010-05-17
Licenses
- License NJ
- 25ma08041900
Location
- Practice location
- 246 HAMBURG TPKE, SUITE 201
- City
- WAYNE NJ
- Postal code
- 074702156
- Phone
- 973-942-1141
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.