| NPI | 1508907692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADEBOLA O ORAFIDIYA Medical Doctor 718-230-5885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 203946) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2010-04-05 |