| NPI | 1467134684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN SUDBERG Owner 631-482-2754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |