| NPI | 1124104435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEVERN JACKSON Nurse Practitioner 171-851-4804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NY F330485) |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2020-08-22 |