| NPI | 1578701835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIYA MAMKIN Responsible Party 718-417-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: NY 054039) |
| Enumeration Date | 2009-01-25 |
| Last Update Date | 2009-01-25 |