| NPI | 1225748494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY THEODORIS Owner 631-993-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2022-11-29 |