| NPI | 1487298485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW LOPEZ Managing Member 516-287-3622 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine |
| 208D00000X General Practice | |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2019-11-01 |