| NPI | 1346789484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY ANN PIDICH Owner 718-548-1104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 006354) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |