Graduated: 2003
NPI: 1609081884
Practice Locations (2)
HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
20 PROSPECT AVE
HACKENSACK, NJ 076011997
HACKENSACK MERIDIAN HEALTH MEDICAL GROUP - SPECIALTY CARE PC
30 PROSPECT AVE
HACKENSACK, NJ 076011915
Source: CMS National Downloadable File, September 2026.