| NPI | 1558520049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER DANIEL HANSEN Owner 631-321-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY x0083681) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-09-09 |