| NPI | 1629529508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MALIS Administrative Coordinator, Mu 718-283-5694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: NY 175663) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2016-10-17 |