| NPI | 1184063596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE GOEZ Manager 516-804-2291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY N004890) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |