| NPI | 1073689600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHELE D MOISE Clinic Billing Manager 516-626-1075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2018-08-21 |