| NPI | 1104189406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHAWAJA ALI HASSAN Owner 516-678-4451 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2012-11-09 |