| NPI | 1417247883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THRESIAMMA MATHEW Owner 718-646-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 247349) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2015-03-08 |