| NPI | 1013413459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY L STEWART Owner 516-373-1222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL Pa3371) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2018-06-16 |