| NPI | 1003503392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTO MORAN Owner 718-902-2244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2025-04-09 |