Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2017-07-11
- Last updated
- 2021-07-19
Specialties
Licenses
- License NJ
- 25MA11001400
Location
- Practice location
- 151 KNOLLCROFT RD
- City
- LYONS NJ
- Postal code
- 079395001
- Phone
- 908-647-0180
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.