| NPI | 1164864369 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS ITSKOVICH President 718-373-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 207492) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2013-07-29 |