| NPI | 1104076165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN ANDREW BROTTMAN Owner 212-969-1899 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 240287) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NY 240287) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2009-03-04 |