| NPI | 1093240954 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOIS STODDARD CFO 718-784-2240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-03-25 |