| NPI | 1508910217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES MISSIG Owner 631-446-1190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: NY 446026-1) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2015-11-12 |