| NPI | 1407022817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUERLINE JEAN Otr/L 718-548-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 012901) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-05-06 |