| NPI | 1558720235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BRIDGET DUPITON Billing Manager 631-385-8677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2018-06-12 |