| NPI | 1518599570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KESHALU SIMPSON VP Of Billing And Credentialing 347-585-9235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2020-02-07 |