| NPI | 1518206366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD GOLDBERG Bookkeeper 516-810-0561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2023-07-15 |