| NPI | 1407191364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LLOYD DOUGLAS SIMON President (Corporation) 631-765-4150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 153210-1) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: NY 153210-1) |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2017-06-14 |