| NPI | 1548899883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAILA DETORE Owner 631-358-1868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-04-08 |