| NPI | 1528602893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MOJICA Billing Credentialing Manager 917-485-7291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2021-01-11 |