| NPI | 1295600948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTOINETTE DEANNA MOORE-THOMAS Np Owner 631-626-4264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-10-10 |
| Last Update Date | 2025-10-20 |