| NPI | 1538392410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAPHAEL DAVIS Chairman 631-444-8070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 305171) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2009-11-16 |