| NPI | 1083647101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORA CARRERO Director Of Credentialing 718-408-6522 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care (Licence: NY 7002148R) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2019-03-13 |