| NPI | 1225320393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE MALANUM SANTOS President 866-667-0517 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 254839) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0505X Family Medicine, Adult Medicine | |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| 207R00000X Internal Medicine | |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| 363LW0102X Nurse Practitioner, Women's Health | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 213E00000X Podiatrist | |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2012-02-20 |