| NPI | 1194990150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTA BERNITT Owner 917-558-5355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY R047904) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2017-02-03 |