| NPI | 1548476328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE A FULGENCIO-DELMONTE Owner 718-334-6725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: NY 203635) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2010-05-12 |