| NPI | 1447016738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANEQUA A BOONE Nurse Practitioner 631-629-2269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-02-23 |