| NPI | 1508904764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARINA PODVAL Owner 718-939-0609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 214459) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 241828) |
| 208800000X Urology (Licence: NY 236385-1) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2020-08-22 |