| NPI | 1396612081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE BLAKE CEO 516-402-0194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-10-20 |
| Last Update Date | 2025-10-20 |