| NPI | 1063590065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN L FANELLI Practice Manager 631-474-6049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |