| NPI | 1184270894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHEBA SUZANNIE TAYLOR Owner 631-433-7506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1744P3200X Specialist, Prosthetics Case Management |
| Enumeration Date | 2019-08-18 |
| Last Update Date | 2019-08-18 |