NPI | 1114950151 |
---|---|
Entity Type | Organization |
Authorized Contact | DEBORA CARRERO Director Of Credentialing 718-408-6522 |
Organization Subpart ? | Yes |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
261QP2300X Clinic/Center, Primary Care | |
Enumeration Date | 2006-07-09 |
Last Update Date | 2019-03-13 |