| NPI | 1104507854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA HADLOCK Owner/Physician 631-998-3495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2023-07-26 |