| NPI | 1629376793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MODDY H KILUVIA M.D. 718-456-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY 232898) |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2011-03-15 |