| NPI | 1619531910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY M. LEGG Credentialing Coordinator 347-584-8903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2019-04-23 |