| NPI | 1104270198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRIGORIY KRICHMAR Owner 631-271-9151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2016-04-16 |
| Last Update Date | 2016-06-25 |