| NPI | 1255868915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MD ABU AHSAN Manager 631-428-1901 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NY 170510010159) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2017-05-12 |