| NPI | 1265538151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES A WALTERS Administrator 631-205-9090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NY 5151207R) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2013-06-19 |