| NPI | 1235745159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIELA PENA Compliance COO Rdinator 516-576-0962 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2020-09-16 |