| NPI | 1578934352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY MCKEEVER Credentialing Coordinator 516-992-4568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 019284) |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2015-10-19 |