| NPI | 1467862029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME SIMON Physician 516-745-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 274300) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-05-05 |