| NPI | 1386941300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON CHARLES DAVIS Medical Director 718-566-0022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 171745) |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2011-02-28 |