Medical school: RUTGERS NEW JERSEY MEDICAL SCHOOL
Graduated: 1991
NPI: 1053344077
Practice Locations (2)
12 -15 BROADWAY, SUITE E
FAIR LAWN, NJ 074102031
2017940910
12 -15 BROADWAY E
FAIR LAWN, NJ 074102031
Source: CMS National Downloadable File, September 2026.