| NPI | 1508457383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH BERNOCCO Provider Enrollment Team Lead 516-945-3163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2023-03-15 |