| NPI | 1053595058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAVIER CHACON Owner 718-302-2126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 215832) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 225308) |
| 225100000X Physical Therapist (Licence: NY 023838) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2008-05-01 |