| NPI | 1568810083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAT JAMES Billing Manager 631-368-1541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2016-05-25 |