| NPI | 1083820583 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE R CARRERO Director Of Credentialing 718-408-6522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X (Licence: NY 8124001A) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2024-07-24 |