| NPI | 1124205232 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYRA B. MERCADO-CAPISTRANO Clinic Manager 718-271-0455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: NY 231220-1) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2008-01-31 |