| NPI | 1154824555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA DEVIVIO Superintendent 631-385-3342 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251B00000X Case Management |
| 252Y00000X Early Intervention Provider Agency | |
| 261Q00000X Clinic/Center | |
| 261QH0700X Clinic/Center, Hearing and Speech | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QX0100X Clinic/Center, Occupational Medicine | |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2018-03-12 |