| NPI | 1013976976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYL B EVERETT Controller 212-361-1678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: NY 01399760) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2020-08-22 |