| NPI | 1154097269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE PETERSON Administrator 631-209-4255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-18 |