| NPI | 1245612803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA GRIER Administrative Secretary 1 718-239-3745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 2084P0804X) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2015-06-19 |