| NPI | 1588248223 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH IWANICKI Practice Admin 917-855-0007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2021-06-15 |