| NPI | 1265857643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KENNEDY Owner 631-923-2139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: NY 7175553) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2019-12-16 |