| NPI | 1114093523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXIS BOSCO Administrative Director 718-788-2594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY 7001121R) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2025-11-20 |