| NPI | 1558634477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL MICHAEL THEAGENE President 631-654-1120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 914218) |
| Enumeration Date | 2012-02-23 |
| Last Update Date | 2012-03-20 |