| NPI | 1407974579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE MARIE LOPEZ Manager Credentialing/Enrollment 516-207-7936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME0061521) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2025-01-21 |