| NPI | 1053367334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE L HERNANDEZ Billing Manager 862-392-0022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2022-09-16 |