| NPI | 1093178428 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | GODWIN MCMUKORO OKPOMO Clinical Director 646-384-0252 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401152) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2016-04-02 |