| NPI | 1295494359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIANNE JORGENSEN Office Administrator 631-743-1145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2022-12-19 |