| NPI | 1619144904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS PETRIKOVSKY Executive Officer 212-725-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NY 163782) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2008-05-15 |