| NPI | 1124081815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYLVIA LINSALATO Credentialing Manager 718-367-8800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 210513) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2020-08-22 |