| NPI | 1417363094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE CHARLES Lpn 917-500-9332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: NY 267754) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2014-07-03 |