| NPI | 1487992871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE E RUSSAK Owner 212-684-5964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 249307-1) |
| Enumeration Date | 2013-01-21 |
| Last Update Date | 2013-01-21 |