| NPI | 1063768174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL YURYEV President 718-444-7774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 254873) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2019-10-04 |