| NPI | 1265508212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIVEK SRA Provider Relations Director 212-729-5365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-08-22 |