| NPI | 1548668452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GRADY MATRISCIANO Managing Member / Owner 516-380-1490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: LA MD202783) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |