| NPI | 1295391985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANN GODBERSON Nurse Practitioner 631-872-2995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2022-10-24 |