| NPI | 1205975646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNDI L GREENE Managed Care Director 631-813-2143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: NY CP2712) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-08-22 |