| NPI | 1275736670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCIA GONZALEZ Provider Enrollment Manager 646-605-4155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2016-01-22 |