| NPI | 1558663518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DASSAN ALI Owner 718-930-1225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 104669432) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2010-11-24 |