| NPI | 1578453551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE CHARLES Owner 516-366-4144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-07-09 |