| NPI | 1255797767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONCEPCION V TAN Sole Owner 718-769-8305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 111610) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2016-01-13 |