| NPI | 1184503088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALENTIN AVANESSOV President 718-891-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2025-08-27 |
| Last Update Date | 2025-08-27 |