| NPI | 1295335784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATASHA SAMANTHA HESCOTT Administrator 347-915-3738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |