| NPI | 1609145846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA PHELPS Office Manager 516-409-4528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: NY 014985) |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2011-12-16 |