| NPI | 1063702710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYELLEN CASSIDY Rpac 516-775-4506 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 002298) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |