| NPI | 1487998480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH KELLY Chief Executive Officer 718-748-7316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-27 |