| NPI | 1265855597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FENAR F THEMISTOCLE Medical Director 347-590-0371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 217744) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-22 |