| NPI | 1225765621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCHY JACKSON Director Of Managed Care 212-238-7815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2025-04-02 |