| NPI | 1457630899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESU JACOB Owner/ CEO 631-670-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: NY 235713) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2016-03-03 |