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300 Central Ave East Orange NJ 07018-2819 | |
| (973) 266-4420 | |
| (973) 266-8490 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 300 Central Ave, East Orange, New Jersey |
| Authorized Official Name and Position | Nicholas Lanza (CFO) |
| Authorized Official Contact | 9734143405 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
300 Central Ave East Orange NJ 07018-2819 Ph: (973) 266-4420 | 300 Central Ave East Orange NJ 07018-2819 Ph: (973) 266-4420 |
| NPI Number | 1992942098 |
|---|---|
| Provider Enumeration Date | 01/12/2009 |
| Last Update Date | 06/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992942098 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 10704 (New Jersey) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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