| NPI | 1255873915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL MCKENNA Administrator 646-712-0448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA OS008678L) |
| Enumeration Date | 2016-11-12 |
| Last Update Date | 2020-06-09 |