| NPI | 1548790934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EBONY WHITE Owner 631-223-8604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health |
| Additional Taxonomies | 261QC1800X Clinic/Center, Corporate Health |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2017-10-30 |