| NPI | 1457011140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL GREENSEID Member 718-769-2521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 111N00000X Chiropractor |
| 208VP0000X | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2025-03-21 |