| NPI | 1225652878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS MALTON CFO 917-204-3810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207R00000X Internal Medicine | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-04-12 |