| NPI | 1629542949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONID BASOVICH President 516-884-2349 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2020-06-04 |