| NPI | 1467102806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA MALLOY Owner 516-266-6186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2023-02-01 |