| NPI | 1104374685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELLA APPIA Manager, Provider Enrollment & Mana 718-483-1270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: NY 7000236R) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2018-04-12 |