| NPI | 1245849231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FUNMILOLA O SIJUADE Pmhnp 917-499-2254 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2023-12-04 |