| NPI | 1508667338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYDEN ALEXANDER HERNANDEZ Senior Credentialing Specialist 631-307-6672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-03-19 |
| Last Update Date | 2025-03-19 |