| NPI | 1306338371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMMANUAL FUZAYLOV Medical Director 718-618-6528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NY 574772) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2018-06-05 |