| NPI | 1457831174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN PHILLIPS Owner 347-813-0535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NY 284515) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 284515) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-08-21 |