| NPI | 1619759842 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMED LATIF Manager/Managed 347-986-8388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family |
| 363LP2300X Nurse Practitioner Primary Care | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2025-03-24 |