| NPI | 1497032957 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID PERRY Clinician 631-219-1131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MA 217636) |
| Enumeration Date | 2011-11-12 |
| Last Update Date | 2011-11-12 |