| NPI | 1164062543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT C TILLMAN Owner 516-238-2283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2020-01-13 |