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1558113910
DIVERSE IPA INC
FLUSHING, NY
NPI
1558113910
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Entity Type
Organization
Authorized Contact
BAOLI ZHANG
President
917-561-0505
Organization Subpart ?
No
Primary Taxonomy
302F00000X Exclusive Provider Organization
Enumeration Date
2024-04-01
Last Update Date
2024-10-01
Business Address
DIVERSE IPA INC
13229 BLOSSOM AVE FL 1
FLUSHING, NY 11355-4915
Phone number: 917-561-0505
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Mailing Address
DIVERSE IPA INC
13229 BLOSSOM AVE FL 1
FLUSHING, NY 11355-4915
Phone number:
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