| NPI | 1306507439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY LYNETTE STEPHENSON Member 917-375-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2021-12-30 |
| Last Update Date | 2021-12-30 |