| NPI | 1598930869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA MOJICA Billing Credentialing Manager 917-485-7291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY 7000286R) |
| Additional Taxonomies | 251V00000X Voluntary or Charitable |
| 261QH0100X Clinic/Center, Health Services (Licence: NY 70451015) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2021-06-15 |