| Na | |
|
48 N Fullerton Ave Montclair NJ 07042-3411 | |
| (973) 744-7337 | |
| (973) 744-5035 |
| Full Name | Na |
|---|---|
| Speciality | Internal Medicine - Geriatric Medicine |
| Location | 48 N Fullerton Ave, Montclair, New Jersey |
| Authorized Official Name and Position | Rowen Gumapas Diano (OWNER) |
| Authorized Official Contact | 9737447337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 48 N Fullerton Ave Montclair NJ 07042-3411 Ph: (973) 744-7337 | Na 48 N Fullerton Ave Montclair NJ 07042-3411 Ph: (973) 744-7337 |
| NPI Number | 1902927874 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 08/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902927874 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | MA69300 (New Jersey) | Primary |
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