| NPI | 1235786419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE R ALLEN Owner 347-559-3139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2019-08-21 |