| NPI | 1518365782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GOPALSWAMY KALYANARAMAN Dentist 718-789-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 034553) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2014-12-19 |