| NPI | 1578563714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELSON R GIRALDO Supervising Physician 631-665-8006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY 175993-1) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2010-05-04 |