| NPI | 1558643114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA A DURKIN Clinical Director 631-885-5464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: NY 369068) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2011-09-09 |