| NPI | 1275820961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M HANNIGAN Physician Billing Mgr 631-465-6213 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2019-11-04 |