| NPI | 1114578416 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA WOOD Pediatric Nurse Practitioner 631-488-0612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2019-09-27 |