| NPI | 1407219447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EGARDO LUGO Clinical Director 646-762-4950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 094687) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |