| NPI | 1548623424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORIN BLAKE Clinical Director 718-398-0153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: NY 094063) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2016-03-30 |