| NPI | 1083967525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CAMACHO President 917-679-9546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: NY 016784) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2012-10-22 |