| NPI | 1124590641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACK LEE SULLIVAN Owner 914-395-3691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2018-12-21 |