| NPI | 1497023964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA R. CARLSEN Medical Director 631-923-0006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 242634) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2020-10-12 |