| NPI | 1073835641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY K. SAMUEL Owner 718-498-7888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: NY 176352) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |