| NPI | 1629523055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS KEVIN HAND Managing Agent 718-984-5869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY X-002011) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: NY 003791-1) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-11-22 |