| NPI | 1104176395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CABAN Patient Care Manager 718-476-7123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: NY 545218-1) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2012-09-14 |