| NPI | 1376141325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACK SULLIVAN Owner 914-395-3691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2023-10-17 |