| NPI | 1205336591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUSAMMAT ROUNAK JAHAN Owner 718-322-4014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 285335) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2018-09-05 |