Provider First Line Business Practice Location Address:
140 EAST RIDGEWOOD AVENUE SUITE 570N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-251-3238
Provider Business Practice Location Address Fax Number:
201-251-3551
Provider Enumeration Date:
04/29/2026