| NPI | 1215399522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY JACKSON Owner 914-260-8087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 336506) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2016-03-25 |