| NPI | 1063424505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISMAIL M ELHAM Medical Director 718-769-4988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 226710) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: NY 226710) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-08-22 |