| NPI | 1326699117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDELL JOSEPH GORUM Owner/Medical Director 718-339-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-09-24 |