| NPI | 1013199116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY MANN Executive Director 646-230-9292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM2500X Clinic/Center Medical Specialty | |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2011-01-31 |