| NPI | 1003514654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KISUN PETERS-DIAZ Executive Director, Foudner 917-861-2531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-05-24 |