| NPI | 1326465394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES E PROVO Vice President Of Operations 917-239-5034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL 67309) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2014-04-22 |