| NPI | 1184133340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID KNOPOV Administrator 718-461-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 046664) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2022-07-21 |