| NPI | 1558792549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY DICANIO Owner 631-665-4392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 210161) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 210161) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 210161) | |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2015-05-27 |