| NPI | 1558134510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM LYNOTT Managing Director 646-871-7599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| 305S00000X Point of Service | |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |