| NPI | 1043428097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY SUPRIN President Medical Director 718-498-3103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 230165) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |