| NPI | 1629344049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EZRA SHARON Physician 718-793-6832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: NY 107333) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-03-29 |