| NPI | 1245832633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT RODRIGUEZ CEO 917-660-3779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2022-07-15 |