Graduated: 1983
NPI: 1609936806
Practice Locations (2)
STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
59 KOCH AVE
MORRIS PLAINS, NJ 079504400
9735381800
SUMMIT OAKS HOSPITAL INC
19 PROSPECT ST
SUMMIT, NJ 079012530
9085227000
Source: CMS National Downloadable File, September 2026.