| NPI | 1588843205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDGAR HENRY Owner 718-469-8131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 0044371) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-30 |