| NPI | 1588104855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE SIERRA Supervisor 718-520-8480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NY 232881) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2017-03-06 |