| NPI | 1104030626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA MARIE VEGA Office Manager 516-238-4235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 231047) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 218280) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2012-04-23 |