| NPI | 1255610887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMASINE FODERA Owner 718-815-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 209637-1) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 204537-1) |
| Enumeration Date | 2011-08-13 |
| Last Update Date | 2011-08-13 |