| NPI | 1215464631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY TANNEBERGER AGNES TANNEBERGER Clinic Director 718-596-4991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NY R035238-1) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2017-05-16 |