Individual
TRI LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(800) 843-2384
Mailing address
201 LYONS AVE, NEWARK, NJ 07112-2027
(800) 843-2384
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26NJ00820500
NJ
Other
Enumeration date
06/28/2018
Last updated
06/28/2018
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