| NPI | 1154790160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY JOSEPH FREDERICK Clinical Director 646-643-4556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NY 246451) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2015-09-21 |