| NPI | 1518197052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAULA PATEL President 7187-336-3669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 203633) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: NY 203633) |
| 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 203633) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: NY 203633) | |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2010-09-02 |