| NPI | 1134492549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MCCOLLIN Director, Medical Staff Services 718-932-7151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 015446) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2012-02-15 |