| NPI | 1417239500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN ANDERSON Administrator 631-265-8780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 231H00000X Audiologist |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |