| NPI | 1487344875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK GLENN BAZEMORE President 917-750-5709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2023-05-10 |