| NPI | 1528883725 |
|---|---|
| Doing Business As | CUSTOM TRT |
| Entity Type | Organization |
| Authorized Contact | AMANDA WIERMANN President 516-652-6509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2024-11-21 |