| NPI | 1053563759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY RESTIVO Director Of Credentialing 516-794-4161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 1225121) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2008-10-14 |