| NPI | 1053183350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHALETTE GILLINGS Employee 631-530-0919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 171400000X | |
| 174H00000X Health Educator | |
| 207KA0200X Allergy & Immunology Allergy | |
| 207N00000X Dermatology | |
| 207Q00000X Family Medicine | |
| 207ZD0900X Pathology Dermatopathology | |
| 208VP0000X Pain Medicine Pain Medicine | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 213E00000X Podiatrist | |
| 225100000X Physical Therapist | |
| 246Z00000X Specialist/Technologist, Other | |
| 247200000X Technician, Other | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-10-30 |