Organization
K PRIMARY CARE AND MEDICAL NUTRITION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAUREEN DOHERTY (CREDENTIALING CONTACT)
(908) 206-4676
Entity
Organization
Contact information
Practice address
571 CENTRAL AVE, SUITE 104, NEW PROVIDENCE, NJ 07974-1547
(908) 206-4676
Mailing address
571 CENTRAL AVE, SUITE 104, NEW PROVIDENCE, NJ 07974-1547
(908) 206-4676
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NJ
Other
Enumeration date
03/30/2015
Last updated
09/01/2015
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