| NPI | 1538540356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA EDWARDS Director Of Recruitment 631-385-7780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2015-06-17 |