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 |