| NPI | 1407291065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA VALENTIN Credentialing Specialist 212-792-8149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |