| NPI | 1457790198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE POULOS Nurse Practitioner 631-495-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401489-1) |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2013-06-16 |