| NPI | 1285993956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VADIM SURIKOV Owner 212-722-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0000X Family Medicine, Adolescent Medicine (Licence: NY 208907) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-10-23 |