| NPI | 1568030021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAILJA BHATTA Credentialing Specialist 212-366-4459 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-06-11 |