| NPI | 1346448784 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VLADIMIR GOTLIEB Provider Relations Specialist 718-333-1394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 218369) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2017-11-28 |