| NPI | 1215617402 |
|---|---|
| Other Name | FOUNTAIN LIFE NY |
| Entity Type | Organization |
| Authorized Contact | BARBARA WOO Director Of Clinical Operations 917-810-8672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2023-07-21 |