| NPI | 1588263016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOLYMAR HERRERA Credentialing Manager 203-777-7411 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |