| NPI | 1518193713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAYDEN RANDLE GOLTZ Member 646-246-3674 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 226840) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2009-06-03 |